Evaluation of reconstruction algorithms in SPECT neuroimaging: I. Comparison of statistical noise in SPECT neuroimages with 'naive' and 'realistic' predictions

In the presence of statistical noise, an iterative reconstruction algorithm (IRA) for the quantitative reconstruction of single-photon-emission computed tomographic (SPECT) brain images overcomes major limitations of applying the standard filtered back projection (FBP) reconstruction algorithm to projection data which have been degraded by convolution of the true radioactivity distribution with a finite-resolution distance-dependent detector response: (a) the non-uniformity within the grey (or white) matter voxels which results even though the true model is uniform within these voxels; (b) a significantly lower ratio of grey/white matter voxel values than in the true model; and (c) an inability to detect an altered radioactivity value within the grey (or white) matter voxels. It is normally expected that an algorithm which improves spatial resolution and quantitative accuracy might also increase the magnitude of the statistical noise in the reconstructed image. However, the noise properties in the IRA images are very similar to those in the FBP images. In fact, the noise magnitude in both the FBP and IRA images is only slightly greater than that computed by the 'naive prediction', which presumably is a lower limit to the amount of statistical noise in a reconstructed image. Thus, the IRA should provide the potential for quantitative SPECT imaging of normal physiological responses or diseases involving both the brain grey and white matter.

A phase III randomized study of 5-fluorouracil and cisplatin versus 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil alone in the treatment of advanced gastric cancer

BACKGROUND

With the introduction of cisplatin-containing regimens in the treatment of advanced gastric cancer, promising clinical results have been reported. A 61.5% response rate was observed with a combination of 5-fluorouracil (5-FU) infusion and bolus cisplatin; however, the superiority of cisplatin-containing regimens to other regimens has not been clearly verified in any randomized controlled studies. A prospective, randomized study of 5-FU and cisplatin (FP) versus 5-FU, doxorubicin, and mitomycin C (FAM) versus 5-FU alone (FU) in previously untreated patients with advanced gastric cancer is reported.

METHODS

A total of 324 patients were entered into the trial and 295 patients (103 for FP, 98 for FAM, 94 for FU) were evaluable. The patients were randomized to receive FP, FAM, or FU after stratifying by the following factors: performance status, presence of measurable disease, and resection of the primary tumor.

RESULTS

The overall response rate for patients with measurable disease in the FP arm was significantly higher than in the FAM and FU arms (51% for FP; 25% for FAM; 26% for FU). The durations of response for each arm, however, were not significantly different. Even though the median time to progression for the FP arm (21.8 weeks) was longer than that for the FAM arm (12 weeks; P < 0.05) and for the FU arm (9.1 weeks; P < 0.005), there was no statistical difference in overall survival among the three arms. Toxicity for all three regimens was moderate and consisted primarily of myelosuppression, nausea, vomiting, and alopecia.

CONCLUSIONS

Although the FP regimen showed a significantly higher response rate and a longer time to progression than the FAM or FU regimens, a survival benefit was not observed.

Arterial thrombosis associated with nephrotic syndrome--a case report and review (adult cases in the English literature)

The thromboembolic complications of nephrotic syndrome are reasonably common, including spontaneous peripheral venous and/or arterial, pulmonary arterial, and renal venous occlusions. However, in comparison to the relatively high incidence of the venous thromboembolic complications with hypercoagulable status, arterial thromboses have been reported much less and it was only 20 cases in the English literature so far. Furthermore, the most cases were pediatric patients rather than adults. Therefore, this report describes an adult nephrotic cases complicated by superior mesenteric artery thrombosis leading to death via catastrophic hospital course. Also, we reviewed the literature in English regarding cases of arterial thromboses in adult nephrotic patients with special interest to locations of thrombosis, underlying histopathologic types of glomerulopathy, and use of steroids or diuretics before its development.

A comparison of the passage of regenerating axons through old degenerated nerve autografts and fresh nerve autografts in rats

We have compared the passage of regenerating axons through old degenerated nerve autografts and fresh nerve autografts in two groups of Sprague Dawley rats. In one group the right sciatic nerve was divided and repaired with the graft taken from the distal segment of the left sciatic nerve, which had been severed 15 weeks before. In the other group the right sciatic nerve was repaired with the graft taken from the intact left sciatic nerve. Eight weeks later the myelinated axons were counted at three different locations in the grafted right sciatic nerve in both groups. The old degenerated nerve autografts were less effective in allowing the passage of regenerating axons than the fresh nerve autografts, but the difference was not great. This provides justification for the use of old degenerated nerve as an additional graft where a large number of autogenous nerve grafts are required, such as in the operative treatment of injuries to the brachial plexus.

Prediction of common folding structures of homologous RNAs

We have developed an algorithm and a computer program for simultaneously folding homologous RNA sequences. Given an alignment of M homologous sequences of length N, the program performs phylogenetic comparative analysis and predicts a common secondary structure conserved in the sequences. When the structure is not uniquely determined, it infers multiple structures which appear most plausible. This method is superior to energy minimization methods in the sense that it is not sensitive to point mutation of a sequence. It is also superior to usual phylogenetic comparative methods in that it does not require manual scrutiny for covariation or secondary structures. The most plausible 1-5 structures are produced in O(MN2 + N3) time and O(N2) space, which are the same requirements as those of widely used dynamic programs based on energy minimization for folding a single sequence. This is the first algorithm probably practical both in terms of time and space for finding secondary structures of homologous RNA sequences. The algorithm has been implemented in C on a Sun SparcStation, and has been verified by testing on tRNAs, 5S rRNAs, 16S rRNAs, TAR RNAs of human immunodeficiency virus type 1 (HIV-1), and RRE RNAs of HIV-1. We have also applied the program to cis-acting packaging sequences of HIV-1, for which no generally accepted structures yet exist, and propose potentially stable structures. Simulation of the program with random sequences with the same base composition and the same degree of similarity as the above sequences shows that structures common to homologous sequences are very unlikely to occur by chance in random sequences.

The mouse Dlx-2 (Tes-1) gene is expressed in spatially restricted domains of the forebrain, face and limbs in midgestation mouse embryos

The pattern of RNA expression of the murine Dlx-2 (Tes-1) homeobox gene is described in embryos ranging in age from E8.5 through E11.5. Dlx-2 is a vertebrate homologue of the Drosophila Distal-less (Dll) gene. Dll expression in the Drosophila embryo is principally limited to the primordia of the brain, head and limbs. Dlx-2 is also expressed principally in the primordia of the forebrain, head and limbs. Within these regions it is expressed in spatially restricted domains. These include two discontinuous regions of the forebrain (basal telencephalon and ventral diencephalon), the branchial arches, facial ectoderm, cranial ganglia and limb ectoderm. Several mouse and human disorders have phenotypes which potentially are the result of mutations in the Dlx genes.

Current transition of the physician's professionalism and doctor-patient relationship

In recent years, the physician's professionalism seemed to be facing or experiencing a phase of change. To investigate this phenomenon, social perception and attitude toward physicians were surveyed and analyzed. The subjects consisted of three types of sample group, namely, the general public, physicians, and medical students. Data were collected through interviews, mailing, and self-administered questionnaire surveys to each sample, respectively. The results of analysis showed us that social evaluation of physicians in Korean society exhibited ambivalent perceptions toward physicians. The physician's occupational status was generally evaluated by the three samples as being in a higher stratum in the social structure. But there were great gaps between their perceptions of the change in the physician's occupational status. While the general public perceived that the physician's status might improve in the future, physicians and medical students predicted an absolute declination of the status. Although the general public sympathized with the physician's characteristics as a professional group, an apparent tendency to assume the attitude of a fairly equal relationship toward physicians has increased. The transitional change in the physician's professionalism could be observed through the ubiquity in the perception of the patient's rights in doctor-patient relationships. Such phenomena are believed to have caused physicians to think that not only has their status declined in recent years but also that this declination of social status would continue in the future.

Impaired homeostatic mechanism of potassium handling after acute oral potassium load in diabetes mellitus

Chronic stable diabetic patients (n = 6) were compared with healthy control subjects (n = 5) after acute oral intake of 50 mEq of potassium chloride (KCl) to investigate for possible derangements of homeostatic responses for acute term (3 hrs) to acute potassium load. Plasma renin activity (PRA), plasma aldosterone (PA), and transtubular potassium concentration gradient (TTKG) known as a useful semiquantative index of distal nephron potassium secretion were measured. All the baseline parameters were comparable between diabetic and non-diabetic subjects except for significantly reduced creatinine clearance in diabetics (mean +/- SEM, 105 +/- 4 vs. 85 +/- 5 ml/min, p < 0.05). Following acute oral KCl load, the peak increases of serum potassium changes from basal levels were noted at 2 hours in both groups, but were higher in diabetic subjects (mean +/- SEM, 0.42 +/- 0.06 vs. 0.62 +/- 0.09 mEq/L). Also, 4 out of 6 diabetic subjects but none of the control subjects at 2 hours after oral KCl load became hyperkalemic ( > 5.0 mEq/L). PRA did not show any significant changes, whereas PA was increased simultaneously with increments in serum potassium in both groups, with blunted increases in the diabetics. However, TTKG was increased prominently in control subjects (8.18 from 4.98), but only slightly in diabetic subjects (4.55 from 4.18), with statistical difference between the two groups (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical techniques and innovations in living related liver transplantation

The authors successfully performed a series of 33 living related liver transplantations (LRLT) on children (15 males and 18 females, ranging from 7 months to 15 years of age) from June 1990 to May 1992, with the informed consent of their parents and the approval of the Ethics Committee of Kyoto University. Before operation, six of the children required intensive care, another 14 were hospitalized, and 13 were homebound. Donors (12 paternal and 21 maternal) were selected solely from the parents of the recipients on the basis of ABO blood group and graft/recipient size matching determined by computed tomography scanning. Procurement of graft was performed using ultrasonic aspirator and bipolar electrocautery without blood vessel clamping and without graft manipulation. All donors subsequently had normal liver function and returned to normal life. The left lateral segment (16 cases), left lobe (16 cases), or right lobe (one case) were used as grafts. The partial liver graft was transplanted into the recipient who underwent total hepatectomy with preservation of the inferior vena cava using a vascular side clamp. Twenty-seven of 33 recipients are alive and well with the original graft and have normal liver function. The patient survival rate was 89% (24/27) in elective cases and 50% (3/6) in emergent cases. The other six recipients had functioning grafts but died of extrahepatic complications. Complications of the graft were minimal in all cases. Hepatic vein stenosis, which occurred three times in two cases, was successfully treated by balloon dilatation. In cases with sclerotic portal vein, the authors anastomosed the portal vein of the graft to the confluence of the splenic vein and the superior mesenteric vein without a vascular graft, after experiencing a case of vascular graft thrombosis. After hepatic artery thrombosis occurred in one of the initial seven recipients whose arterial anastomosis was done with surgical loupe, microsurgery was introduced for hepatic artery reconstruction. There has been no occurrence of thrombosis since then. The current results with LRLT suggested that the meticulous management of surgical factors at each stage of the LRLT procedure is crucial for successful outcome. Living related liver transplantation is a promising option for resolving the graft shortage in pediatric liver transplantation and may be regarded as an independent modality to supplement cadaver donation.

Estimation of relative regional neuroreceptor concentration by PET or SPECT: Theoretical comparisons of using a single late image or a late plus early image

The potential for using a single (SPECT) single-photon-emission computed tomography or (PET) positron emission tomography image to estimate quantitatively the relative regional neuroreceptor concentration depends on acquiring the image at a time when changes in the regional radioactivity localization are much more sensitive to changes in receptor concentration than to changes in delivery. Using the binding of [(11)C]carfentanil to the opiate receptor as a model, the authors have applied a computer simulation approach to determine the joint and marginal probability distributions for the ipsilateral/contralateral ratio of receptor concentrations and delivery. They have found that the probability distributions depend on the sensitivities for both delivery and receptor. Incorporation of data at an early time point results in a significant sharpening of the probability distributions. There is an insignificant effect of subtraction of the radioactivity localization in a control region.

Retinoids for the future: investigational approaches for the identification of new compounds

One desired goal for future retinoid development is the dissociation of therapeutic benefit from teratogenic risk. It is not known if this result can be achieved, but increasing our understanding of the molecular mechanisms of retinoid action offers rational approaches to the attainment of this goal. The basis for these new approaches is the recent discovery of nuclear receptors for all-trans-retinoic acid and for the 9-cis form of retinoic acid. These receptors, like the steroid hormone receptors, are ligand-dependent transcription factors. Retinoids act by binding to these receptors and modulating specific gene pathways that ultimately control cell differentiation and development. Retinoic acid is required for normal embryonic development, and retinoic acid concentrations are regulated in the developing embryo. The malformations associated with in utero exposure to retinoids might be the result of inappropriate activation of specific receptors and inappropriate modulation of specific gene pathways. At least three nuclear receptors for all-trans-retinoic acid and three nuclear receptors for the 9-cis form of retinoic acid are known to exist, with the two receptor subfamilies interacting to form heterodimers. This multiplicity of receptors and receptor interactions suggests that differences may exist among receptors in the biologic effects they mediate. Although some retinoid ligands are not specific, others are highly selective for one particular receptor. Contrasting the effects of ligands with different specificities should increase understanding of the biologic responses associated with specific receptors and efforts to dissociate therapeutic activity from undesired effects.

Compartmental analysis of RBC circulation through the rabbit kidney

This experiment involved 12 rabbits of both sexes, weighing 2.1 kg. After anesthesia, the kidneys were exposed, isolated and cannulated in the renal artery, ureter and sometimes in the vein as well. The kidney were perfused through the renal artery with Krebs-Henseleit solution, which were then filtered to be free of particles, gased with 95% O2-5% CO2, and kept at 37 degrees C. We measured RBCs concentrations by means of Coulter Counter in the venous outflow collected, and plotted them against the volume perfused. Using 2 different flow rates, 9 ml/min (group I) and 19 ml/min (group II), we found that the RBCs decreased in a multiexponential decay fashion and a biophysical model for each flow rate was constructed. These models indicated that there were more cell stores (2.20 x 10(10)) in the fast compartment of group II than in group I (1.72 x 10(10)). This difference is not statistically significant, but certainly coincides with urine flow collected from ureter cannula during perfusion. Our present data clearly suggest that in order to clear 99% blood cells out of 10-12 gm rabbit kidneys, at least 3-6 ml of cell free perfusate is required while clearing the whole blood cells out of human kidneys (200-240 gm) may need 600 ml or more. Thus, we recommend that at least 600 ml of perfusate should be used to clear most of the blood cells in the renal vasculature before renal transplantation is performed.

The use of a spectrophotometric assay to study the interaction of S-adenosylmethionine synthetase with methionine analogues

We have developed a continuous spectrophotometric assay for S-adenosylmethionine synthetase and, using this assay, have examined the interaction of five potential inhibitors with the E. coli enzyme. S-Vinylhomocysteine and S-allylhomocysteine were found to be substrates, while S-(methanethio)cysteine and S-(methanethio)homocysteine were found to be competitive inhibitors. S-Cyanohomocysteine is neither a substrate nor an inhibitor.

Acquired tufted angioma associated with pregnancy

Acquired tufted angioma is a distinctive condition that is different from other types of acquired vascular proliferation. Despite the progressive spread of these angiomas, they appear to be benign, and malignant change has not been encountered. We describe a case of recurrent acquired tufted angioma associated with pregnancy, an association which has not been previously recorded.

Simultaneous expression of keratin and glial fibrillary acidic protein by the same cells in epiretinal membranes

The identification of cells comprising epiretinal membranes is difficult because of the phenotypic changes that occur. Examination of intermediate filament protein content by immunocytochemical analysis can help to identify some cells with altered ultrastructure but is not always definitive because altered expression of intermediate filament proteins can also occur. To examine this issue further, the authors utilized a postembedding immunocytochemical technique with epiretinal membranes in which they were able to double label for keratin, a useful marker for identifying retinal pigment epithelial cells, and glial fibrillary acidic protein (GFAP), a useful marker for identifying glial cells. Nine of ten idiopathic epiretinal membranes contained cells that labeled for GFAP and not keratin. Two of these membranes also contained cells that labeled only for keratin and one membrane contained cells that simultaneously labeled for both GFAP and keratin. Other types of epiretinal membranes had an equal participation by cells that expressed only GFAP or keratin (12 of 17 membranes contained cells positive for keratin; 13 of 17 contained cells positive for GFAP). Ten of 17 nonidiopathic membranes contained cells simultaneously expressing GFAP and keratin, although they comprised only a minor subpopulation of the total number of cells present. These findings demonstrate that keratin and GFAP are not mutually exclusive intermediate filament proteins in cells of epiretinal membranes and that, although each may provide a helpful adjunct for cell type identification, neither is an absolutely specific marker.

Mutation creates an open reading frame within the 5' untranslated region of macaque erythrocyte carbonic anhydrase (CA) I mRNA that suppresses CA I expression and supports the scanning model for translation

A variant allele at the CA I locus that produces a deficiency of erythrocyte-specific CA I occurs as a widespread polymorphism in pigtail macaques from southeast Asia. Sequence analyses revealed a C----G substitution 12 nucleotides downstream of the cap site in the variant erythrocyte CA I mRNA. This mutation forms a new AUG start site and an open reading frame coding for 26 amino acids that terminates 6 nucleotides before the normal AUG initiation codon for CA I. It appears that the presence of this upstream open reading frame greatly diminishes reinitiation of translation from the normal start site, resulting in trace levels of CA I in erythrocytes. Preferential use of the first AUG codon supports the scanning model for translation initiation in eukaryotes.

Clinical application of arterialization of portal vein in living related donor partial liver transplantation

Arterialization of the portal vein was employed during hepatic arterial reconstruction in our first few clinical experiences of partial liver transplantation using liver grafts obtained from living related donors. This procedure reduced the time required for revascularization of the grafts to about 25 min, and could in fact reduce the ischemic phase of the grafts. Repeated practice of the clinical transplantation technique has shortened the time needed to complete vascular reconstruction, eliminating the need for this procedure in most of our subsequent cases. In many clinical cases, however, there may be emergency situations which require vascular reconstruction, resulting in a prolongation of ischemic phase and the deterioration of the cellular viability of the graft. In such situations, arterialization of the portal vein can be a useful way to prevent the prolongation of the ischemic phase and to rescue the graft.

[Comparative study on the effectiveness of modified Kato's cellophane thick smear and Stoll's dilution egg counting technique for quantitative fecal examination of helminth eggs]

A total of 197 fecal specimens was prepared for quantitative examination of helminth eggs by modified Kato's cellophane thick smear (M.C.T.S.) and Stoll's dilution egg counting technique (D.E.C.T.). The comparative effectiveness of two techniques was evaluated and conversion function was deduced. The average time required for the microscopic examination on one slide by M.C.T.S. was 12.6 minutes and that of D.E.C.T. was 14.6 minutes. M.C.T.S. showed lower false negative rate than D.E.C.T. in light worm burden cases. Functions to convert the counts obtained by M.C.T.S. to E.P.G. by Stoll's dilution egg counting technique were 47.86 x 10(0.87) logM.C.T.S. in A. lumbricoides, 41.69 x 10(0.82) logM.C.T.S. in T. trichiura and 63.10 x 10(0.85) logM.C.T.S. in C. sinensis. It was suggested M.C.T.S. be better than D.E.C.T. for the quantitative examination of intestinal helminthiases such as A. lumbricoides, T. trichiura, and C. sinensis infections even in the cases with low worm burden.

1,25-Dihydroxy-vitamin-D3 enhances antiproliferative effect and transcription of TGF-beta1 on human keratinocytes in culture

Both TGF-beta and 1,25-dihydroxy-vitamin-D3 (1,25(OH)2D3) have been reported to decrease the proliferation of normal human keratinocytes. The effect and expression of TGF-beta in keratinocytes treated with 1,25(OH)2D3 was investigated. Human keratinocytes were grown in the presence of various concentrations of TGF-beta and/or 1,25(OH)2D3 prior to enumeration. TGF-beta, alone, has a half maximal dose of inhibition (ED50) of approximately 750 pg/ml after seven days in culture in Keratinocyte Growth Medium (KGM; Clonetics) supplemented with 1.5 mM calcium. When 1,25(OH)2D3 (10(-7)M) was also added to cultures with various concentrations of TGF-beta, the ED50 shifted an average of 2-fold less. The presence of TGF-beta (10 pg/ml) augmented the potency of 1,25(OH)2D3 by at least 10-fold. In keratinocyte cultures, the antiproliferative effect of the two compounds together is synergistic. In keratinocytes grown for 1 week in the presence of 1,25(OH)2D3 at 10(-6)M, the TGF-beta 1 message increased approximately 5-fold. An increase is detected within 2 hours of exposure to 1,25(OH)2D3. There was only a 50% increase in the levels of TGF-beta 2 and no detection of TGF-beta 3. When keratinocyte cultures were treated with 1,25(OH)2D3 and neutralizing antibodies to TGF-beta, the induced-antiproliferative activity was blocked by more than 50%. The keratinocytes produced more active than latent TGF-beta after growth with high doses of 1,25(OH)2D3.

Compensation for three-dimensional detector response, attenuation and scatter in SPECT grey matter imaging using an iterative reconstruction algorithm which incorporates a high-resolution anatomical image

The use of SPECT to diagnose physiological alterations in disease states depends on the potential of SPECT to provide a quantitatively accurate reconstructed image. However, the reconstructed values depend upon the shape and size of the brain region as strongly as they depend upon true radioactivity concentration. We report here the results of applying an iterative reconstruction algorithm (IRA) to compensate for shape- and size-dependence, as well as for attenuation and scatter. The IRA is designed only for the reconstruction of images for which the true radioactivity in the white matter within the actual brain is negligible compared with the true radioactivity in the grey matter within the actual brain. The IRA incorporates an accurate three-dimensional model of detector response and utilizes an MRI image which defines the anatomical features of the brain being imaged by segmenting the grey, white and ventricular regions. It is the assumption of radioactivity localization exclusively in the grey matter which permits the efficient incorporation of the MRI image. The IRA was validated by simulation studies that utilized a slice through the basal ganglia in the realistic Hoffman three-dimensional mathematical brain model. FBP images deviate significantly from true radioactivity distribution, whereas IRA images are nearly identical to true radioactivity distribution, except for random fluctuations due to the presence of statistical noise. These results indicate that the application of the IRA will permit SPECT to distinguish deficits due to true physiological changes from apparent deficits due to imaging/reconstruction artifacts.

Homeostasis of sulfate and 3'-phosphoadenosine 5'-phosphosulfate in rats after acetaminophen administration

Acetaminophen (AA) is a drug whose biotransformation by sulfation is easily saturated. We have previously demonstrated in rats that its dose-dependent kinetics appear to be due to depletion of 3'-phosphoadenosine 5'-phosphosulfate (PAPS). In order to determine if the depletion of PAPS might be due to a lack of inorganic sulfate, we characterized the effect of AA not only on the homeostasis of PAPS but also on its precursor, sulfate. The maximum excretion of AA-sulfate was observed after 75 mg/kg of AA, i.p., and higher dosages did not increase its excretion. AA dosages between 150 to 600 mg/kg, i.p., 2 hr after dosing depleted 60 to 80% of hepatic PAPS. Hepatic PAPS levels returned to control values 16 to 20 hr after dosing with 600 mg/kg of AA. AA decreased serum sulfate to a similar degree (80%) and duration (16 hr) as did hepatic PAPS. AA also lowered sulfate concentrations in liver, but to a somewhat lesser extent (65%) than in serum. Hepatic sulfate levels returned to control values at 16 to 24 hr after dosing with AA. Even though AA did not alter renal PAPS concentrations, it did produce a 65% decrease in the renal sulfate levels. In summary, these studies demonstrate that AA markedly depletes PAPS concentrations in liver, but not in kidney, and drastically decreases serum and tissue sulfate concentrations. Our findings indicate that the capacity-limited sulfation of AA is due to the limited availability of hepatic PAPS, which in turn is limited by the availability of sulfate in liver.