Nitrogen concentration control during diamond growth for NV- centre formation

Negatively charged nitrogen-vacancy (NV-) centres formed in diamond crystals are point defects that have potential applications in various quantum devices such as highly sensitive magnetic sensors. To improve the sensitivity of magnetic sensors using NV- centres, it is essential to precisely control the nitrogen concentration in the crystals. In this paper, we demonstrated that nitrogen concentration in diamond can be controlled with high precision for the following two representative growth methods. One is the high-pressure/high-temperature (HPHT) synthesis method and the other is the chemical vapour deposition (CVD) method. The nitrogen concentration of HPHT-grown diamond decreased semi-logarithmically with increasing contents of titanium or aluminium as nitrogen getter materials. The nitrogen concentration of CVD-grown diamond increased linearly with increasing the flow rate ratio of nitrogen to carbon. NV- centres were formed by controlling the total fluence of electron beams so that approximately 20% of the nitrogen became NV- centres. The coherence time of electron spin of NV- centres obtained by the Hahn-echo pulse sequence T2 of these diamond crystals was inversely proportional to the nitrogen concentration. A comparison of T2 of the NV- centres for HPHT-synthesized and CVD-grown diamonds showed no significant difference between them. This article is part of the Theo Murphy meeting issue 'Diamond for quantum applications'.

Tissue Cooling and its Effect on Brightness Temperatures by Contact-Type Microwave Applicators

Contact of an applicator on the skin surface may cool the tissues so that the resulting brightness temperature measured by the applicator is varied. The tissue cooling effect on the brightness temperature was quantitatively evaluated. From the experimental results, it was concluded that an accurate temperature control was needed in order to reduce the errors in the brightness temperature. A new method of temperature control which permits continuous measurement of the thermal responses of a human body was attempted, and advantages and disadvantages of the method are discussed. The research results may be practical and useful for the accurate measurement of brightness temperature.

Homogeneous heating of a sample space by a modified heating assembly in a belt-type high-pressure apparatus

To create homogeneous heating in the sample space in a belt-type high-pressure apparatus, modified heating assemblies under pressure of 2.5 GPa and temperature up to 1700 °C were examined. Counterbores (with several diameters) were made at both ends of a cylindrical graphite heater to suppress the temperature gradient along the cylindrical axis of the heater. Temperature distributions within the heaters were measured by thermocouples and geothermometers. Both sets of measurements revealed that the temperature distribution in the sample space (6.9 mm outside diameter/12 mm length) was homogenized (i.e., variation of less than 10 °C under heating at 1700 °C) by optimizing the heater shape.

In vivo time-resolved DOT measurement and image reconstruction of human forearm under exercises

In vivo measurement of time-resolved diffuse optical tomography (TR-DOT) were performed for human forearms under the exercises. The DOT images of oxygenation state were reconstructed, and the activities of the inner muscles were assessed.

Influence of Behavioral and Environmental Factors on the Development of Obesity in Three-year-old Children -A Case-Control Study Based on Toyama Study-

Obesity in children seems to be a risk factor for chronic diseases in adulthood. From the viewpoint of preventive medicine, factors influencing the development of obese children should be removed early in life.The purpose of this study was to the elucidate relationship between obesity in 3-year-old children and both behavioral and environmental factors by conducting a case-control study. Subjects were selected from the Toyama study. Matched-pair comparisons were performed between obese children whose Kaup's index was 18 or more (N=117) and control children (N=234) . Multivariate stepwised logistic regression analysis also applied to assess influence of confounding factors.The results indicated that the following 6 factors significantly influenced the development of obese 3-year-old children in exact Fisher's method analysis (p<0.05): person other than the mother responsible for taking care of the child, short sleep duration (9 hours or less), physical inactivity, eating snacks irregularly, overweight father (BMI≥24), and overweight mother (BMI≥24). For both sexes, after adjusting for confounders by multivariate stepwise logistic analysis, overweight mother (OR 2.54, 95 % CI 1.64-3.95), birth overweight (birth weight≥3,500g; OR 1.76, 95 % CI 1.15-2.69), the mother not responsible for taking care of the child (OR 1.65, 95% CI 1.10-2.48), overweight father (OR 1.62, 95%CI 1.09-2.40), eating snacks irregularly (OR 1.56, 95% CI 1.04-2.33), and gender (female;OR 0.51, 95% CI 0.34-0.77) had significant relationships with obesity in childhood. For boys, overweight mother (OR 2.53, 95 % CI 1.47-4.35), birth overweight (OR 2.03, 95%CI 1.22-3.39), eating snacks irregularly (OR 1.94, 95 %CI 1.19-3.18), and birth month (36-41 months; OR 0.47, 95 % CI 0.23-0.96) had significant relationships. For girls, overweight mother (OR 2.62, 1.28-5.35), and short sleep duration (OR 2.24, 1.11-4.52) had significant relationships. In neither Fisher's exact method nor multivariate logistic models, time to wake up, bedtime, duration of playing outdoors, regularity of meals, care about salty food, or frequency of eating snacks had significant relations with obesity in 3-year-old children (p<0.05).

Intracellular uptake of a new boronated porphyrin EC032

We measured the toxicity and intracellular uptake of a newly developed boronated porphyrin EC032, and verified the fluorescence-based boron concentration measuring methods. Toxicity study showed that concentration required to produce a 50% reduction in viability (IC(50)) of EC032 was more than 0.25 mM. Fluorescence study showed the intracellular uptake of EC032 increased up until 24 h after its exposure to C6, 9L, U87, and U251 cells. There was also a linear correlation between ICP-AES and fluorescence intensity as an arbitrary unit about measurement of boron concentration. Fluorescence-based boron concentration measuring methods are very simple and useful methods, especially for screening of slight test dose of porphyrin compounds.

The development of Weinstein's noise sensitivity scale

Many studies have shown the significant correlation between noise annoyance and noise sensitivity identified by Weinstein's noise sensitivity scale (WNS). However, the validity of the scale has not been sufficiently assessed. This study was designed to investigate the validity of each question in WNS and to develop a more valid noise sensitivity measurement scale. A questionnaire study was conducted in a residential area along trunk roads in Kusatsu, Japan, and 301 responses were collected. In this paper, noise sensitivity was defined as the factor that induced individual variability in reactions caused by noise exposure and that is not affected by the noise exposure. The relationship between noise exposure and answers to each question in WNS was investigated by multiple logistic regression analysis, and the influence of response bias on the score of WNS was examined. The results showed that WNS contained some questions that were inappropriately related to noise exposure level and that the score was affected by response bias. The reported correlation between annoyance and the score of WNS could be confounded by noise exposure and response bias. A noise sensitivity measurement scale named WNS-6B was newly developed, excluding the biased questions from the original WNS and applying binary coding to six-response options in order to reduce the response bias. WNS-6B seemed to be more appropriate to assess noise sensitivity than the original scale.

Imaging capability of an early stage breast tumor by CP-MCT

Capability of diagnostic imaging of an early stage breast tumor using microwaves has been investigated by means of FDTD-based numerical simulations. More than ten years ago, we developed chirp pulse microwave computed tomography (CP-MCT) for microwave imaging of a human body. In this study, we'll show that CP-MCT provides useful information on the tumor region in the breast. To specify the exact location of an early stage tumor inside the breast, image restoration has been attempted by computing the point spread function (PSF) of CP-MCT in two- or three-dimensional ways by assuming the function is linear. Another solution is given by using radar imaging system simultaneously with CP-MCT.

Akt activation and localisation correlate with tumour invasion and oncogene expression in thyroid cancer

INTRODUCTION

Akt activation is involved in the pathogenesis of inherited thyroid cancer in Cowden's syndrome and in sporadic thyroid cancers. In cell culture, Akt regulates thyroid cell growth and survival; but recent data suggest that Akt also regulates cell motility in non-thyroid cell lines. We therefore sought to evaluate the role of Akt in thyroid cancer progression.

METHODS

We evaluated 46 thyroid cancer, 20 thyroid follicular adenoma, and adjacent normal tissues samples by immunohistochemistry for activated Akt (pAkt), Akt 1, 2, and 3, and p27 expression. Immunoblots were performed in 14 samples.

RESULTS

Akt activation was identified in 10/10 follicular cancers, 26/26 papillary cancers, and 2/10 follicular variant of papillary cancers, but in only 4/66 normal tissue samples and 2/10 typical benign follicular adenomas. Immunoactive pAkt was greatest in regions of capsular invasion; and was localised to the nucleus in follicular cancers and the cytoplasm in papillary cancers, except for invasive regions of papillary cancers where it localised to both compartments. Immunoactive Akt 1, but not Akt 2 or Akt 3, correlated with pAkt localisation, and nuclear pAkt was associated with cytoplasmic expression of p27. In vitro studies using human thyroid cancer cells demonstrated that nuclear translocation of Akt 1 and pAkt were associated with cytoplasmic p27 and cell invasion and migration. Cell migration and the localisation of Akt 1, pAkt, and p27 were inhibited by PI3 kinase, but not MEK inhibition.

DISCUSSION

These data suggest an important role for nuclear activation of Akt 1 in thyroid cancer progression.

Experimental validation of a linear model for data reduction in chirp-pulse microwave CT

Chirp-pulse microwave computerized tomography (CP-MCT) is an imaging modality developed at the Department of Biocybernetics, University of Niigata (Niigata, Japan), which intends to reduce the microwave-tomography problem to an X-ray-like situation. We have recently shown that data acquisition in CP-MCT can be described in terms of a linear model derived from scattering theory. In this paper, we validate this model by showing that the theoretically computed response function is in good agreement with the one obtained from a regularized multiple deconvolution of three data sets measured with the prototype of CP-MCT. Furthermore, the reliability of the model as far as image restoration in concerned, is tested in the case of space-invariant conditions by considering the reconstruction of simple on-axis cylindrical phantoms.

Severe thyrotoxicosis induced by thyroid metastasis of lung adenocarcinoma: a case report and review of the literature

A 50-year-old woman who had undergone lung lobectomy because of lung adenocarcinoma presented with thyrotoxicosis, neck swelling, and cervical lymphadenopathy one month after the operation. The total serum triiodothyronine (T3) and thyroxine (T4) levels were markedly elevated to 514 ng/dL and 26.4 microg/dL, respectively, and serum thyrotropin (TSH) was suppressed to less than 0.005 microU/mL. Although the thyroid gland had been normal before surgery, chest computed tomography (CT) scan revealed a markedly enlarged thyroid gland only 1 month after surgery. 123I uptake for 24 hours was suppressed to 4% in the thyroid gland with no uptake elsewhere including the lung. Fine-needle aspiration cytology (FNAC) of the thyroid showed invasion of poorly differentiated adenocarcinoma cells, cytologically identical to the cells obtained from sputum and those infiltrating the resected sections of the lung adenocarcinoma. Immunohistochemical studies of resected lung tissues did not show positive staining for thyroglobulin, carcinoembryonic antigen (CEA), or surfactant protein A. Clinically, the thyrotoxicosis had spontaneously improved, followed by a hypothyroid state with shrinkage of the thyroid gland after chemotherapy. Despite repeated chemotherapy and the administration of thyroxine for hypothyroidism, the patient died of respiratory failure 9 months after the onset of thyrotoxicosis. From these findings and the clinical course, thyroid metastasis, developing subacutely from lung adenocarcinoma, was diagnosed. We speculate that aggressive invasion of tumor cells into the thyroid gland resulted in highly destructive thyrotoxicosis.

Re-evaluation of the latent period of bladder cancer in dyestuff-plant workers in Japan

BACKGROUND

The carcinogenesis of benzidine (BZ) and beta-naphthylamine (BNA) for bladder is well known. Although it was thought to be rare to develop occupational bladder cancer more than 20 years after the exposure to these chemicals, there are still new clinical cases even 30 years after exposure. The purpose of this study was to re-evaluate the latent carcinogenic period of BZ and BNA, in order to set the safety period after exposure for the health surveillance system.

METHODS

The subjects were 236 dyestuff-plant workers in Tokyo, who had been exposed to these dyestuffs. The incidence of bladder cancer and its histopathology in this group was surveyed in the period from 1962 to 1996.

RESULTS

Nineteen workers (8.1%) were found to have bladder cancers. The exposure period for these 19 patients was 82.0 +/- 50.2 months. The mean +/- SD latent period from the subjects' initial and final exposure until tumor development was 29.5 +/- 8.2 years and 20.1 +/- 10.6 years, respectively. Significantly, a negative correlation (Pearson) was observed between the exposure period and the latent period from the end of exposure to cancer onset (R = -0.544, P < 0.05). All tumors except one were transitional cell carcinoma. Flow cytometric analysis was performed in 11 patients and all of these patients had DNA aneuploidy.

CONCLUSIONS

The latent periods of bladder cancer caused by BZ and BNA were longer than previously expected. It is necessary to survey the onset of bladder cancer in exposed workers more than 30 years after the initial exposure.

[Usefulness of washout rate analysis in adenosine triphosphate-stress thallium-201 myocardial scintigraphy in patients with vasospastic angina]

OBJECTIVES

This study evaluated the usefulness of washout rate analysis in adenosine triphosphate(ATP) stress thallium-201 scintigraphy for the diagnosis of vasospastic angina.

METHODS

This study included 76 patients with vasospastic angina and 18 normal controls undergoing coronary arteriography. If significant coronary artery stenosis (> or = 50%) was pointed out, the subject was excluded from this study. 111 MBq of thallium-201 was intravenously injected 3 min after ATP loading (0.16 mg/kg/min) was started. Single photon emission computed tomography (SPECT) was performed 10 min and 4 hr after intravenous injection of ATP. The mean washout rate (%) was calculated based on a bull's eye map and was divided into 3 regions, the antero-septal/lateral/inferior regions. The washout rate in each region was calculated. Regional uptake was visually estimated based on the 17 segments of SPECT images.

RESULTS

The washout rate in the normal control group was 48.9 +/- 4.1 (mean +/- SD)%. In patients with vasospastic angina, the washout rate in areas with coronary vasospasm was 33.4 +/- 5.5%. This value was significantly lower than in the areas without coronary vasospasm (42.8 +/- 3.6%). The usefulness of washout rate analysis in the diagnosis of vasospastic angina with a cut-off value of less than -2SD from normal washout rate in the 3 regions was examined. A significantly higher diagnostic value was found by washout rate analysis (sensitivity 72.3%, specificity 79.7%, and accuracy 74.6%) compared with visual evaluation of early images (sensitivity 50.3%, specificity 73.9%, and accuracy 57.5%).

CONCLUSIONS

The diagnostic value of washout rate analysis was significantly higher (73.1%) compared with visual evaluation of early images (50.3%) in patients with multivessel vasospastic angina.

Seasonal variation in heart rate variability in asthmatic children

Asthma is a "seasonal disease" with symptoms either aggravated by environmental changes during specific seasons or prevalent at certain times of the year for other reasons. We examined whether the heart rate variability (HRV) of asthmatic children changes by season. The HRV during a portion of one night (00:00-04:00) and day (12:00-16:00) and the entire 24h period (00:00-24:00) during each of the four seasons was analyzed. The data of 95 children with asthma and 106 healthy children, as controls, were assessed. In children with asthma during the 24h period, seasonal variation in the low-frequency (LF) band (0.04-0.15 Hz) and the high-frequency (HF) band (0.15-0.4 Hz) were detected (HF: F=6.81, p=.0003; LF: F=4.18, p= .008). The HF value in the summer was significantly higher than in autumn and spring (Scheffe test: autumn vs. summer, s = 4.46, p < .001: spring vs. summer, s = 2.86, p < .05), while the LF value in autumn was significantly lower than in summer (s = 3.42, p < .01). In the control group, no seasonal variation in HF, LF, or LF/HF was detected. The findings infer the HRV, a surrogate measure of autonomic nervous system function, of asthmatic children is more susceptible to seasonal changes brought about by either endogenous annual rhythms or environmental weather phenomena.

Image restoration in chirp-pulse microwave CT (CP-MCT)

Chirp-pulse microwave computed tomography (CP-MCT) is a technique for imaging the distribution of temperature variations inside biological tissues. Even if resolution and contrast are adequate to this purpose, a further improvement of image quality is desirable. In this paper, we discuss the blur of CP-MCT images and we propose a method for estimating the corresponding point spread function (PSF). To this purpose we use both a measured and a computed projection of a cylindrical phantom. We find a good agreement between the two cases. Finally the estimated PSF is used for deconvolving data corresponding to various kinds of cylindrical phantoms. We use an iterative nonlinear deconvolution method which assures nonnegative solutions and we demonstrate the improvement of image quality which can be obtained in such a way.

Volume-weighted mean nuclear volume. Is this new prognosticator comparable in different institutions?

OBJECTIVE

To determine whether volume-weighted mean nuclear volume (MNV) obtained at one institution is comparable to that from other institutions.

STUDY DESIGN

MNV calculated from histologic slides obtained at three hospitals--Shizuoka Prefectural Hospital (SPH), Shimada Municipal Hospital (SMH) and Shizuoka City Hospital (SCH)--were compared. Between December 1994 and June 1996, transurethral resection of bladder tumor or transurethral resection of the prostate was performed on 37 patients at SPH and 50 patients at SMH; histologic specimens from 40 cases of bladder tumors, 63 cases of normal bladder mucosa, 28 cases of benign prostatic hyperplasia and 1 case of prostate cancer were obtained. A portion of each specimen obtained at SPH or SMH was carried to SCH, and histologic slides were made at SCH using it. Using the remaining position of each specimen, histologic slides were then prepared at each hospital. Estimates of MNV were made from all histologic slides from each hospital, and the differences in MNV between the hospitals were analyzed. In addition, intraobserver and interobserver reproducibility were analyzed using 50 specimens obtained between December 1994 and August 1995.

RESULTS

On linear regression analysis, comparison of MNVs calculated from the histologic slides from SPH and SCH and those calculated from SMH and SCH revealed high correlation coefficients (R = .966 and .966, respectively), and the slope of the regression line did not differ significantly from unity. The paired t test also disclosed no significant difference between MNVs calculated at the two hospitals. Furthermore, the correlation coefficients for intraobserver and interobserver reproducibility of MNV estimates were also high (R = .918 and .949, respectively).

CONCLUSION

The results of this study indicate that estimates of MNV are comparable in multiple institutions, and we recommend that they be used to support subjective histologic grading.

Neuro-psychological discorders and renal cell carcinoma: a case report and a psychological study of urological cancer patients

Several pathways for immunodepression induced by stress and injury have been speculated, with precise analysis regarding out correlations between sympathetic nerve system and immunodepressive cytokines. Here, we show an interesting case and a clinical study of psychological disorders of urological advanced cancer patients. In the case report, a male renal-cell cancer patient whose disease disappeared following interferon therapy is presented whose disease relapsed five years after therapy and eight months after a traffic injury. Careful observation of the history suggests that severe pain could destruct patient's own anti-cancer mechanisms. In the clinical study on psychological disorders of the 131 patients, a higher rate (28%) of disorders was recognised in renal-cell cancer patients than in other cancer patients. Serum CRP values of the renal-cell cancer patients with the disorders was significantly higher than those of the same cancer patients without the disorders. A complicated inter-relationship between the central nercous system, various external forces, the cancer itself and the immune system may exist and have an influence on the efficacy of biotherapy.

Serum leptin levels and bioelectrical impedance assessment of body composition in patients with Graves' disease and hypothyroidism

We investigated whether thyroid status modulates serum leptin concentrations and body composition as determined by bioelectric impedance analysis (BIA). The percent body fat mass (%FM) in male Graves' disease was significantly lower than that in age- and sex- matched normal subjects, at the levels of 11.4+/-6.4% (mean+/-SD) vs 19.9+/-9.2% for men (n=12, P<0.05) but not for women (22.6+/-7.6% vs 24.9+/-13.1%, n=28). In contrast, in female hypothyroidism (n=11) %FM was significantly higher than that in normal subjects (32.9+/-11.5%, P<0.01). Among other body composition parameters, the percentage of body water (%BW), and lean body mass (LBM) were significantly lower in hypothyroid patients, and the ECM (extracellular mass)/BCM (body cell mass) ratio was significantly (P<0.0001) increased in Graves' disease which was the result of marked depletion of BCM with concomitant expansion of ECM. The serum leptin levels were significantly decreased in male Graves' patients (2.3+/-0.7 ng/ml, P<0.05), whereas in female Graves' patients (8.8+/-5.9 ng/ml) and patients with hypothyroidism (9.5+/-7.6 ng/ml), the levels were not different from those of normal controls matched for BMI or %FM. There was a positive correlation between serum leptin levels and %FM in female Graves' patients (r=0.635, P=0.001) and in hypothyroid patients (r=0.801, P=0.014) but not in male Graves patients. There was no significant relationship between serum leptin levels and thyroid hormones, TRAb, or TSAb. In euthyroid obese subjects there was a positive relationship between serum leptin levels and serum TSH levels (r=0.37, P<0.01). These results suggest that hyperthyroidism is characterized by the decreased fat mass and serum leptin levels in men, but female patients appear to be resistant to the effect of thyroid hormones. Together with previous reports, thyroid status has a minor role in the regulation of serum leptin levels.

[Relationship of dietary habits pattern and body build of parents to child obesity]

Patterns of eating habits were analyzed to elucidate its relationship to the temporal change of body build from childhood through school age in subjects of the Toyama study. Survey questionnaires at the time of entrance to elementary school were used. Subjects were 6,452 (males 3,293, and females 3,159). Subjects were classified into 6 clusters among the males, 8 clusters among females based on the results of cluster analysis of eating habits. The cluster in males that preferred egg, milk, dairy products, fats, fish and shellfish, soybeans, fruits, green yellow vegetables indicated more frequent subjects whose BMI were less that 14. The cluster in girls that preferred fats indicated more frequent subjects whose BMI were more or equal to 18. The ANOVA showed significant relation of parental body build on their children. Even after grouping by parental body build, the cluster based on patterns of eating habits showed different frequencies of obese children. Preference for intake of milk indicated less frequent obese children among the similar parental body build for boys, while preference for intake of fats indicated more frequent obese children among a similar parental body build for girls. In conclusion, the obesity of a school child has a close relationship to parent's body build. However, the temporal changes of obesity were seen among eating habits clusters even if body builds of their parents are the same. It was shown that patterns of eating habit are important in school children's obesity development.

The role of volume-weighted mean nuclear volume in predicting disease outcome in patients with prostate cancer treated with radical prostatectomy

BACKGROUND

Estimates of volume-weighted mean nuclear volume (MNV) are the only means by which unbiased estimates of three-dimensional parameters can be obtained from single two-dimensional sections without any assumptions. We have reported that for prostate cancer estimates of MNV are prognostically equal or superior to morphological grading of malignancy, such as Gleason score (GS), and in particular, that MNV proved to be a meaningful predictor of prognosis for patients with clinically localized tumors. However, all previous studies were conducted on patients treated conservatively, and no authors have tested whether estimates of MNV can predict the prognosis of patients treated with radical prostatectomy.

MATERIALS AND METHODS

A retrospective prognostic study of 52 patients with clinically localized prostate cancer diagnosed at three Hospitals in Shizuoka Prefecture, Japan (Shizuoka City Hospital, Shizuoka Prefectural Hospital and Shimada Municipal Hospital) and treated by radical prostatectomy was performed. Twenty of these patients were treated with hormone therapy before radical prostatectomy. Unbiased estimates of MNV were compared with clinical stage, histological grading according to GS and neo-adjuvant hormone therapy with regard to the prognostic value.

RESULTS

MNV was significantly correlated with pathological T stage, but was not significantly correlated with the presence or absence of lymph node metastasis. Univariate analysis revealed that MNV correlated significantly with progression-free survival (p = 0.0116). Multivariate analysis revealed that MNV (p = 0.0115) and GS (p = 0.0275) were two significant independent predictors of progression-free survival.

CONCLUSIONS

The results of the present study suggest that MNV and GS are powerful independent predictors of prognosis for prostate cancer treated with radical prostatectomy. We recommend estimates of MNV as a supportive method to the histological grading for patients with prostate cancer.

Orthotopic ileal neobladder in male patients: functional outcomes of 66 cases

BACKGROUND

Orthotopic urinary diversion has become the preferred form of bladder reconstruction after cystectomy. We report on our experience with 66 male patients undergoing this procedure from November 1990 to February 1998.

METHODS

A neobladder was constructed using an ileal segment with a Hautmann type bladder. Complications were assessed and subdivided into early and late types. Voiding function was evaluated in terms of voiding pattern and continence. Median follow up was 19.5 (range 3.5-87.7) months.

RESULTS

There was one (1.5%) perioperative death. The most frequent pouch-related and unrelated early complications were persistent urine leak (7.6%) and prolonged ileus (16.7%), respectively, the majority of cases of which were managed conservatively. Analysis of late complications revealed 6.2% ureteroileal stenosis and 1.5% urethrointestinal stenosis rates, but no case of bladder stone formation. Of the 61 patients in whom voiding function was evaluable, 95.1% achieved excellent daytime continence, while only 67.2% had night-time continence. With regard to posture at voiding, 23 (37.7%) voided in a sitting position. Three of the patients (4.9%) were unable to void and required regular intermittent catheterization.

CONCLUSIONS

An orthotopic neobladder can be constructed with acceptable morbidity and excellent functional results. We believe that orthotopic urinary diversion offers an attractive alternative to a bladder substitute when cystectomy is required.

Economic evaluation of alternative indicators for screening for diabetes mellitus

BACKGROUND

the optimal indicator for screening for diabetes mellitus without relying on fasting conditions was clarified.

METHODS

the subjects were 891 men ages 26 through 80 years (48.5 +/- 8.5). The objectives of this study were (1) to elucidate the efficacy of 1,5-anhydroglucitol (1,5-AG), glycosylated hemoglobin, and fructosamine (FRA) as screening tests for non-insulin-dependent diabetes mellitus (NIDDM) or for impaired glucose tolerance (IGT) and (2) to perform an economic evaluation for each indicator. The efficacy of each indicator was evaluated by drawing the receiver operating characteristic curves and calculating the areas under these curves (AUCs). An original model was developed for the pur pose of cost-effectiveness analysis.

RESULTS

each indicator was evaluated as a screening test for NIDDM alone and for both IGT and NIDDM. The AUCs of 1,5-AG and fasting plasma glucose were the largest in the case of the detection of NIDDM alone and the detection of both IGT and NIDDM, respectively. FRA was, however, the most cost-effective in Japan.

CONCLUSION

using equations, we indicated the equi librium points at which the cost-effectiveness ratios of each indicator intersected in order to generalize the results. By calculating the appropriate-actual ratios of costs for each indicator, we could ascertain the optimal indicator for each country.

Volume-weighted mean nuclear volume as a prognostic factor in renal cell carcinoma

Volume-weighted mean nuclear volume (MNV) has been reported to have important prognostic value in many cancers. We investigated the prognostic value of MNV in patients with renal cell carcinoma (RCC). A retrospective study of the 155 patients with RCC treated by radical nephrectomy between 1976 and 1996 was conducted. MNV was evaluated in the surgical specimens using a stereologic technique. Univariate analyses by the log-rank test and then a multivariate analysis by the Cox proportional hazards model were performed to analyze the prognostic value of histopathologic parameters such as Robson stage, tumor-node-metastasis (TNM) classification, tumor grade, and MNV. There were significant correlations between MNV and Robson stage, TNM classification and tumor grade. Robson stage, TNM classification, tumor grade, and MNV were correlated significantly with disease-specific survival of RCC patients. There was no significant difference in disease-specific survival between patients with Grade 1 and Grade 2 tumors (94.8% of all patients), but MNV could predict the clinical outcome of these groups. MNV also was correlated significantly with disease-specific survival at all tumor stages. Multivariate analysis showed pT classification, M classification, tumor grade, and MNV to be independently associated with survival. These studies strongly suggest that MNV may provide new and useful information to accurately predict the prognosis of patients with RCC.

[Laparoscopic nephropexy for symptomatic nephroptosis: a case report]

We present our clinical findings of laparoscopic nephropexy performed on a 32-year-old woman with symptomatic nephroptosis. Supine and erect excretory urography (DIP) revealed right renal descent of 2.5 vertebral bodies with hydronephrosis. Laparoscopic transperitoneal nephropexy was performed using nonabsorbable sutures, polyglactin net, hernial staplers and tissue adhesive. An upright DIP 1 month postoperatively revealed renal descent of only 1 vertebral body and no hydronephrosis. One year postoperatively, the patient is asymptomatic. A laparoscopic procedure, which is safe, effective and causes minimal morbidity, represents an excellent approach for repair of symptomatic nephroptosis.

Clinical characteristics of amiodarone-induced thyrotoxicosis and hypothyroidism in Japan

Since amiodarone was introduced in Japan in 1992, the incidence of the drug-induced thyroid dysfunction has been increasing. We studied the thyroid function of 13 patients with amiodarone-induced thyrotoxicosis (AIT) and 11 patients with amiodarone-associated hypothyroidism (AAH) who had been referred to our Institute in the last 6 years. AIT and AAH developed after 39+/-21 and 20+/-16 months of amiodarone treatment, respectively. One patient developed AAH followed by AIT. The AIT ranged from subclinical to overt thyrotoxicosis. Four patients with moderate to marked AIT were treated with methimazole. Their thyrotoxicosis persisted for 3 to 9 months, despite administration of antithyroid agents. One patient with mild thyrotoxicosis was treated with prednisolone, resulting in a euthyroid state in a few months. Eight patients with asymptomatic to moderate thyrotoxicosis resolved spontaneously without any treatment. In four asymptomatic patients with AIT, serum levels of T3 and T4 were in the upper normal range or slightly high (< 12 microg/dl), accompanied by suppressed TSH (<0.1 microU/ml) and high thyroglobulin levels, suggesting destruction-induced thyrotoxicosis. Such a subclinical thyrotoxicosis developed repeatedly in one patient. Ultrasonographic studies revealed no nodular lesion in the thyroid, and color flow Doppler sonography demonstrated no hypervascularity in the thyroid gland in any AIT patient. Although it is postulated in Europe that there are two types of AIT, namely type I, which develops in patients with latent Graves' disease or toxic multinodular goiter, and type II, which develops in an apparently normal thyroid as destructive thyroiditis, all AIT patients we have seen so far had developed destructive type AIT. Sufficient intake of iodide and a very low incidence of toxic multinodular goiter may account for the rare incidence of type I AIT in our country. Mild to moderate AIT resolved spontaneously without discontinuing amiodarone, but it was discontinued in two of 13 AIT patients because of extrathyroidal adverse reactions.

Temporal course of the development of obesity in Japanese school children: a cohort study based on the Keio Study

OBJECTIVE

To demonstrate the temporal course of obesity development in Japanese school children by conducting a school-site cohort study over 12 years.

METHODS

From 1981 to 1984, height and weight of 479 subjects (343 boys and 136 girls) were measured every year from entrance into primary school until graduation from high school in Tokyo. Obese children were defined as those with a body mass index (BMI) at or above the age-sex-specific standard value, derived from Japanese nationwide data.

RESULTS

Approximately 50% of the children who were obese in the primary school period were obese at age 17. Likewise, 40% who were obese in the junior high school period and 70% who were obese in the high school period were obese at age 17. Among 44 children who were obese at age 17, 14 showed tracking of obesity from the preschool period, 14 showed tracking from ages 7 to 11 years, 10 showed tracking from the junior high school period, and 6 showed tracking from the high school period.

CONCLUSIONS

Among children who were obese at age 17, most tracked from the primary school age or earlier. The earlier the tracking commenced, the greater the BMI at age 17. This indicates the importance of conducting health education for school children at an early age.

Growth hormone directly inhibits leptin gene expression in visceral fat tissue in fatty Zucker rats

Growth hormone (GH) is known to interact with adipose tissue and to induce lipolysis. Adipocytes produce leptin which regulates appetite and energy expenditure. In order to elucidate the role of GH in leptin production, we studied the effect of GH on leptin gene expression and body fat in fatty Zucker rats, a model of obesity with resistance to both leptin and insulin. Recombinant human GH administered subcutaneously at 0.5 mg/kg per day (low dose) as well as at 1.65 mg/kg per day (high dose) reduced leptin mRNA levels in epididymal fat tissue but not in subcutaneous fat tissue after 7 days. GH administration only at the high dose reduced percentage body fat. Insulin-like growth factor-I infusion (200 microg/kg per day) did not change percentage body fat or leptin mRNA levels in epididymal fat. These observations suggest that GH directly interacts with adipose tissue and reduces leptin gene expression in visceral fat tissue.

Granulomatous nephritis as a complication of intrarenal bacille Calmette-Guérin therapy

A case of granulomatous nephritis after intrarenal bacille Calmette-Guérin (BCG) therapy is reported. High fever greater than 38.5 degrees C lasted for 1 month, without response to conservative therapy. Standard nephroureterectomy was subsequently carried out. Histopathologic findings from the surgical specimen were compatible with BCG-induced granulomatous nephritis. The use of a syringe pump for retrograde instillation of BCG was thought to be the major cause of this severe complication.

Prognostic significance of flow cytometric deoxyribonucleic acid analysis for patients with superficial bladder cancers: a long-term follow-up study

Flow cytometric DNA ploidy analysis for human bladder cancers may provide significant diagnostic and prognostic potential. We have previously reported that combined use of histologic and flow cytometric parameters may offer additional information regarding the clinical outcome for bladder cancer patients. However, the evaluation included both superficial and muscle-invasive tumors. In the present manuscript, we present our study on whether flow cytometric determination yields significant prognosticators beyond the classical histologic evaluation only in the patient with superficial bladder cancer. A total of 217 patients with untreated bladder cancer were evaluated, using fresh bladder tumor specimens. Tumor grading (grade 1, 2, and 3) and stage (pTa + pT1a and pT1b) served as the histologic prognostic parameters. Multiple flow cytometric parameters assessed included DNA index, percentage S-phase cells, percentage G2/M-phase cells, and hypertetraploid cell presence. Multivariate survival analysis was performed using the SAS proportional hazard regression procedure to study statistical individual prognostic values of both the histologic and the flow cytometric parameters. Clinical follow-up of more than 60 months was required, with the mean follow-up being 116.3 +/- 18.6 months. Hypertetraploid cell presence was the single most important prognostic factor (p < 0.01; risk ratio: 14.3), with the second being tumor grade (p < 0.05; risk ratio: 4.6). No other parameters, including tumor stage, the DNA index, and cell phase fractions, contributed to the model. These results indicate that hypertetraploid cell presence found by flow cytometric determination may provide additional information regarding the clinical outcome for superficial bladder cancer patients, and can be used as an indicator for decision making in treatment of superficial bladder cancer patients.

The role of volume-weighted mean nuclear volume in predicting disease outcome in patients with stage M1 prostate cancer

BACKGROUND

Various factors have been reported to be of value in predicting the prognosis of prostate cancer. Gleason score (GS) and prostate-specific antigen (PSA) are the two most powerful prognosticators among them. We previously reported that estimation of volume-weighted mean nuclear volume (MNV) was a more useful prognosticator for prostate cancer than subjective histologic grading. In this study, we compared estimates of MNV with PSA and GS for predicting the prognosis of stage M1 prostate cancer.

EXPERIMENTAL DESIGN

A retrospective prognostic study of 66 patients with stage M1 prostate cancer diagnosed between January 1989 and December 1996 at Shizuoka City Hospital and Shizuoka Prefectural Hospital was performed. The prognostic value of unbiased estimates of MNV were compared with PSA and histologic grading according to GS.

RESULTS

Univariate analysis revealed that estimates of MNV (p=0.0136) and post-treatment nadir PSA level (p<0.0001) correlated significantly with the prognosis of stage M1 prostate cancer, whilst GS (p=0.9377), pre-treatment PSA level (p=0.7377) and rate of decrease in PSA level within 1 month after the beginning of therapy (p=0.8999) had no prognostic value. Multivariate analysis revealed that post-treatment PSA level and estimates of MNV were the two most powerful prognosticators.

CONCLUSIONS

This study indicates that estimation of MNV is an important prognosticator, in conjunction with post-treatment nadir PSA level, in stage M1 prostate cancer.

Effect of cytokines on production of insulin-like growth factor binding proteins (IGFBPs) from human fibroblasts in culture

Bioactivity of Insulin-like growth factors (IGEs) are positively or negatively regulated by IGF binding proteins (IGFBPs). Like IGFs, production of IGFBPs are influenced by a number of hormonal factors. We studied the effects of cytokines on production of IGFBPs in human fibroblasts in culture. Both IL-1beta and TNF-alpha inhibited IGFBP-3 (42/38 KDa species) production in a concentration dependent manner judged by Western ligand blot. Expression of IGFBP-3 mRNA was also decreased by these cytokines. Moreover, the treatment with IL-1beta and TNF-alpha resulted in appearance of smaller mol weight (26 KDa) immunoreactive IGFBP-3 fragment(s) which lacked the ability to bind 125I-IGFs, indicating that these cytokines degrade IGFBP-3 via activation of proteases. Both IL-1beta and TNF-alpha decreased production of IGFBP-4, whereas they increased that of IGFBP-6, IL-6 had little effect on production of IGFBPs. Likewise, interferon-gamma failed to affect of production of IGFBPs except at high concentrations. The present data demonstrate that cytokines, especially IL-1beta and TNF-alpha are potent regulators of IGFBPs production and degradation. These cytokines may alter tissue uptake of IGFs and help to counteract the catabolic state induced by them.

Interaction between leptin and growth hormone (GH)/IGF-I axis

In order to identify the mutual interaction between GH and leptin, we studied the effect of GH on fatty Zucker rats. GH administration at a high dose (5.0 IU/kg) reduced % body fat after 7 days. The leptin mRNA level in subcutaneous fat tissue was not changed but that in epididymal fat tissue was decreased by an even lower dose of GH (1.5 IU/kg). IGF-I treatment (200 microg/kg/day) did not change the % body fat or leptin mRNA level. These observations suggest that GH directly interacts with visceral fat and reduces fat mass and leptin expression. We also measured serum leptin levels in patients. The levels in patients with acromegaly were significantly lower than those in normal subjects with the same amount of body fat, but serum IGF-I and urinary C peptide excretion rates were higher in the acromegalic. These observations also suggests that GH directly interacts with adipose tissue and reduces leptin expression. Next we investigated the direct action of leptin on GH release from the pituitary. Leptin pretreatment of pituitary cells in culture or rats in a fasted or fed condition did not change GRH induced GH secretion. As indicated also by other recent studies, leptin may increase GRH or decrease somatostatin secretion by the hypothalamus. Thus GH interacts with fat tissues and leptin may be a good marker of the interaction.

Influence factors on the development of obesity in 3-year-old children based on the Toyama study

BACKGROUND

Obesity in childhood increases the risk of obesity in adulthood. Obesity in adulthood is a risk factor for chronic diseases such as hypertension and atherosclerosis. Therefore, it is important to eliminate factors influencing the development of obesity in children from the viewpoint of preventive medicine. The purpose of this study is to elucidate the relationship between obesity and lifestyle in 3-year-old children in a case-control study.

METHODS

Subjects were selected from the Toyama study at health checkups for 3-year-old children which are done routinely by local governments in Japan on all children of that age. A special questionnaire consisting of items on lifestyle and environmental factors of the children and past histories of parents was distributed to the Toyama study participants beforehand and was collected at the checkup. Matched-pair comparisons were performed between obese children whose body mass index was 18 or more (N = 427) and control children (N = 854) matched by sex and birth month. Multivariate stepwise conditional logistic regression analysis was also applied to assess the influence of confounding factors.

RESULTS

The following six factors significantly influenced the development of obese 3-year-old children using the Mantel-Haenszel method: the mother's job, limited playtime outdoors (1 hour or less), snacking irregularity, an overweight father (body mass index >/= 24), an overweight mother (body mass index >/= 24), and overweight at birth (birth weight >/= 3,500 g). An overweight mother or father, limited playtime outdoors, overweight at birth, and snacking irregularity were significantly related to obesity in 3-year-old children after adjusting for confounding factors by multivariate stepwise conditional logistic regression analysis.

CONCLUSIONS

We have suggested several factors influencing the development of obesity in 3-year-old Japanese children: parental overweight and overweight at birth as host factors, physical inactivity and snacking irregularity as behavioral factors, the mother's job as an environmental factor.

New approach in the evaluation of a fitness program at a worksite

The most common methods for the economic evaluation of a fitness program at a worksite are cost-effectiveness, cost-benefit, and cost-utility analyses. In this study, we applied a basic microeconomic theory, "neoclassical firm's problems," as the new approach for it. The optimal number of physical-exercise classes that constitute the core of the fitness program are determined using the cubic health production function. The optimal number is defined as the number that maximizes the profit of the program. The optimal number corresponding to any willingness-to-pay amount of the participants for the effectiveness of the program is presented using a graph. For example, if the willingness-to-pay is $800, the optimal number of classes is 23. Our method can be applied to the evaluation of any health care program if the health production function can be estimated.

Effect of growth hormone (GH) on serum concentrations of leptin: study in patients with acromegaly and GH deficiency

As leptin, an ob gene product, plays a pivotal role in the regulation of adiposity and energy homeostasis, the level of its expression is likely to fluctuate under various physiological, nutritional, and disease conditions. Reports regarding the effect of GH on serum leptin levels are inconsistent. We have measured serum leptin levels and correlated them with several variables in patients with acromegaly, patients with adult GH deficiency (GHD), and normal controls. In 116 normal subjects, the mean serum concentration of leptin was 5.0+/-2.8 (mean +/- SD) ng/mL in men (n = 42) and 10.7+/-7.3 ng/mL in women (n = 73), respectively. As reported previously, the leptin levels in women were significantly (P < 0.001) higher than in men, and there was a strong positive correlation between log-transformed serum leptin levels and percent body fat in simple regression analysis (in men: r = 0.606; P < 0.0001; in women: r = 0.707; P < 0.0001). In 36 acromegalic patients, the percent body fat mass was significantly lower than that in normal subjects, and the mean serum leptin level was 2.2+/-1.8 ng/mL in men (n = 18) and 3.6+/-2.5 ng/mL in women (n = 18). Analysis of covariance revealed that serum leptin levels in acromegalics were significantly lower than those in normal subjects after correcting percent body fat (P = 0.016 for men and P < 0001 for women). In male patients with GHD (n = 20), the mean percent body fat was significantly (P < 0.05) higher than that in age-matched controls, whereas the value in female GHD patients (n = 15) did not differ from that in age-matched controls. Serum leptin levels in GHD patients were 5.1+/-2.5 ng/mL in men and 11.5+/-8.1 ng/mL in women, which were not different from those in normal subjects adjusted for percent body fat mass. In multiple regression analysis models with log-transformed leptin as the dependent variable, gender, percent body fat (or body fat mass), and serum insulin-like growth factor I levels entered the equations at a statistically significant level. These data suggest that excess GH/insulin-like growth factor I reduces serum leptin levels by reducing body fat mass and/or by unknown mechanisms.

[The effect of quality of life in Behçet disease patients on subjective life satisfaction]

The purpose of this study is to elucidate the relationships between subjective life satisfaction and the following 8 factors of quality of life: physical condition, daily living activities, working condition, economic status, social status, medical status, marriage status, mental status. One hundred and fifty-four male and 116 female Behçet patients in 13 medical facilities were analyzed in this study. Mantel-Haenszel's odds ratio method and stepwise logistic regression analysis were applied to evaluate the influence of quality of life on subjective life satisfaction in Behçet disease patients. Males had higher problem scores than females in the following: physical condition, daily living activities, working condition, economic status, social status, marriage status, mental status. With regard to the effect on subjective life satisfaction, physical condition, daily living activities, working phase, economic phase, social phase, marriage relations, mental phase showed significantly high odds ratio in male, while physical condition, working phase, economic phase, social phase, medical phase, marriage relations, mental phase showed significantly high odds ratios in females by Mantel-Haenzel age-adjusted method. Physical condition, daily living activities, working phase, economic phase, social phase, and mental phase showed significantly high odds ratios in males after adjusting for active disease symptom periods, while physical condition, working phase, economic phase, social phase, medical phase, marriage relations, mental phase showed significantly high odds ratio in females after adjusting for active disease symptom. By stepwise logistic regression analysis, working phase and mental phase in males, economic phase and mental phase in females were shown to be significant. Improvement of quality of life including mental phase and working phase appear to raise the life satisfaction in Behçet's disease patients.

HRA model for hypercholesterolemia based on a longitudinal health database

To evaluate the risk factors for hypercholesterolemia, we examined 4,371 subjects (3,207 males and 1,164 females) who received medical checkups more than twice at an AMHTS in Tokyo during the period from 1976 through 1991; and whose serum total cholesterol was under 250 mg/dl. The mean follow-up duration was 6.6 years. A self-registering questionnaire was administered at the time of the health checkup. The endpoint of this study was the onset of hypercholesterolemia when the level of serum total cholesterol was 250 mg/dl and over. We compared two prognosis groups (normal and hypercholesterol) in terms of age, examination findings and lifestyle. After assessing each variable, we employed Cox's proportional hazards model analysis to determine the factors related to the occurrence of hypercholesterolemia. According to proportional hazards model analysis, total cholesterol, triglyceride and smoking at the beginning, and hypertension during the observation period were selected in males; and total cholesterol at the beginning and age were selected in females to determine the factors related to the occurrence of hypercholesterolemia.

Health risk assessment for diabetes mellitus based on longitudinal analysis of MHTS database

This study was designed with a follow up of 16 years to provide the epidemiological model evaluating the risk of developing diabetes mellitus in Japan. A cohort of 2573 subjects (1851 males and 722 females) from a MHTS in Tokyo, who were nondiabetic (fasting blood glucose (FBS) less than 110 mg/dl) in the initial year, were selected. This cohort was followed every year to identify the occurrence of diabetes mellitus. Diabetes Mellitus was defined as fasting blood glucose over 110 mg/dl, or the initiation of diabetic therapy. We compared two prognosis groups (a normal group and a diabetic group) in terms of age, examination findings, and prevalence of health risks (lifestyle, stress, and working form). We also assessed family history of diabetes and past histories including hypertension, hypercholesterolemia, and hyperuricemia. After assessing each variable by univariate analysis (t-test, chi 2 test), we employed Cox's proportional hazards model analysis. We used stepwise model adopting risk factors. The diabetic group had significant differences compared to the normal group in age, BMI (body mass index), FBS, smoking, drinking, not eating breakfast, dairy intake, hypertension, hypercholesterolemia, hyperuricemia, and family history by univariate analysis. According to proportional hazards model analysis, FBS, age, family history, hypertension, smoking, and BMI were incorporated into significant risk factors for diabetes in males, and not eating breakfast, FBS, age, drinking, and hypertension were incorporated in females. Diabetes seemed to be related to fixed factors (age), or genetic factors (family history and FBS) in males. For females, lifestyle (not eating breakfast and drinking habit) seemed to play an important role. It will be worthwhile to assess the risks of developing diabetes mellitus by this epidemiological model.

HRA Model for Hypercholesterolemia Based on a Longitudinal Health Database

To evaluate the risk factors for hypercholesterolemia, we examined 4,371 subjects (3,207 males and 1,164 females) who received medical checkups more than twice at an AMHTS in Tokyo during the period from 1976 through 1991; and whose serum total cholesterol was under 250 mg/dl. The mean follow-up duration was 6.6 years. A self-registering questionnaire was administered at the time of the health checkup. The endpoint of this study was the onset of hypercholesterolemia when the level of serum total cholesterol was 250 mg/dl and over. We compared two prognosis groups (normal and hypercholesterol) in terms of age, examination findings and lifestyle. After assessing each variable, we employed Cox's proportional hazards model analysis to determine the factors related to the occurrence of hypercholesterolemia. According to proportional hazards model analysis, total cholesterol, triglyceride and smoking at the beginning, and hypertension during the observation period were selected in males; and total cholesterol at the beginning and age were selected in females to determine the factors related to the occurrence of hypercholesterolemia.

[Evaluation of marble burying behavior: induced alteration of monoamine metabolism in mouse brain]

Evaluation of marble burying behavior (MBB) housing-induced alteration of monoamine metabolism in mouse brain was performed by measuring metabolite levels with HPLC-ECD. Isolated housing of mice, each in a cage (22 x 32 x 14 cm; sawdust, 1-mm diameter; 5 cm in thickness) with 15 evenly spaced glass marbles on the floor (2.5-cm diameter; control, without marbles) for 24-168 hr, 5-HIAA contents were decreased in three regions: the midbrain, thalamus and hypothalamus. 5-HT turnover was not inhibited except for in the hypothalamus due to the decreases of 5-HT in the other two regions. On the other hand, DOPAC content and DA turnover were decreased in four regions: striatum, midbrain, thalamus, hypothalamus. The decrease in hypothalamic monoamine neurons was observed notably after 72 hr of MBB housing. No alterations were observed in feeding, water-drinking, spontaneous locomotor activity, number of buried marbles, serum corticosterone and serum glucose concentrations during MBB keeping compared with the control mice. These results suggested that the isolated mouse housed in a cage with evenly spaced glass marbles for a long period may be a model animal for alteration of monoamine metabolism in brain regions without physical infringement.

[Effectiveness of magnetic resonance angiography for mass screening of unruptured intracranial aneurysms]

Magnetic resonance angiography (MRA) is widely used in screening for unruptured intracranial aneurysm (UIA) in the prevention of onset of subarachnoid hemorrhage (SAH) in Japan. However, the clinical efficacy of mass screening of UIA using MRA has not been established. This study aims to establish the clinical efficacy of mass screening of UIA using MRA by decision-making. The decision tree is constructed simulating a flow of population (100,000 persons, aged 50-59) starting from the MRA screening until the final outcomes of quality adjusted life or death in ten years. In order to estimate the numerical values various parameters were used as follows, prevalence rate: 1%; sensitivity of MRA: 74%; specificity of MRA: 76%; death rate by intracranial angiography: 0.1%; rupture rate of UIA: 2%/year; death rate of SAH: 57%; and death rate for surgery for UIA: 0.0%. The following results were obtained: 1. The number of lives saved by the MRA screening was 760, while the number saved without MRA was 79. 2. The number of deaths in those receiving the MRA screening was 52, while the number of deaths without MRA was 104. 3. The level of quality adjusted life with the MRA screening was higher than that without MRA in all cases. In conclusion, mass screening of UIA using MRA appears to be effective.

Increased concentration of vascular endothelial growth factor/vascular permeability factor in cyst fluid of enlarging and recurrent thyroid nodules

Human thyrocytes produce vascular endothelial growth factor (VEGF), a potent angiogenic factor, also known as vascular permeability factor (VPF), which increases vascular permeability. Based on the assumption that VEGF/VPF is involved in fluid accumulation in thyroid cysts, we determined the VEGF/VPF concentration in cyst fluids of thyroid nodules from 79 patients. VEGF/VPF was found to be abundantly present in the cyst fluids (0.02-183 ng/mL). There was no significant difference of VEGF/VPF concentration in the cyst fluid obtained from thyroid adenoma or from adenomotous goiter with cystic degeneration. Immunoreactive VEGF/VPF in cyst fluid was eluted mainly at 45 kDa, and stimulated endothelial cell proliferation, which was partially blocked by anti-VEGF/VPF antibody. The VEGF/ VPF concentration in the cyst fluid obtained from patients who required repeated aspiration or underwent surgical resection because of recurrent accumulation (84.8 +/- 58.3 ng/mL, mean +/- SD, n = 18) was significantly higher than that in the cysts that regressed or disappeared after a single aspiration (4.3 +/- 4.4 ng/mL, n = 12, P < 0.001). These in vitro and clinical findings suggest that VEGF/VPF is at least partly involved in the accumulation of cyst fluid in thyroid nodules, and that a high VEGF/VPF concentration predicts rapid accumulation of the cyst fluid, possibly necessitating interventional treatment.

Oncostatin M: a new potent inhibitor of iodine metabolism inhibits thyroid peroxidase gene expression but not DNA synthesis in porcine thyroid cells in culture

The functions of thyroid cells are regulated by a number of cytokines and growth factors in addition to TSH. Recent studies have revealed that several cytokines including interleukin (IL)-6 are involved in thyroid dysfunction. Oncostatin M (OSM) is a glycoprotein belonging to the same family of cytokines as IL-6, to which it is related by sequence and structural homology and the use of the signal-transducing receptor component gp130. We, therefore, studied the effect of OSM on iodide uptake and DNA synthesis by porcine thyroid cells in culture. OSM increased c-fos and c-jun mRNA levels but did not stimulate DNA synthesis. OSM inhibited iodide uptake stimulated by TSH; while IL-6 also inhibited iodide uptake, it was only about one-tenth as potent. IL-6 had about the same potency as OSM when it was added with soluble IL-6 receptor. OSM had no effect on cAMP production but inhibited iodide uptake stimulated by 8-bromo-cAMP and forskolin. These findings suggest that OSM exerts its inhibitory effects at the post-cAMP production step(s). OSM also inhibited thyroid peroxidase mRNA levels but had little effect on thyroglobulin mRNA levels. Investigations of the signal transduction system showed that gp130 and leukemia inhibitory factor (LIF) receptor beta subunit mRNA were detectable in porcine thyroid cells by reverse transcription (RT)-polymerase chain reaction (PCR). Together with the report that serum OSM and IL-6 concentrations are elevated to the same levels in patients with sepsis, these results suggest that OSM may contribute to the thyroid dysfunction in this condition.

Controllability of temporomandibular joint loading by coordinative activities of masticatory muscles: a two-dimensional static analysis

Masticatory and bite forces, when applied to the teeth, generate tremendous compressive energy in the temporomandibular joint (TMJ). Excessive 'TMJ loading', if left untreated, deteriorates articular functions. Normally, it is controlled, to a certain extent, by stomatognathic means. In an attempt to clarify this control mechanism, we analyzed the relationship between TMJ loading and the activities of the masticatory muscles, by employing a static two-dimensional jaw model. This comprises two rigid bodies, the upper and lower jaws, including three dominant muscles, i.e. the masseter, the anterior portion of the temporalis and the lateral pterygoid. Static equilibrium analyses determined that TMJ loading can be minimized, under controlled bite conditions, by pointing the loading vector in a direction solely indicated by individual morphological factors, such as the position and orientation of the masseter and the temporalis. This theoretically optimum direction of TMJ loading was also anatomically acceptable, because the load is applied exactly to those portions of the articular disk and mandibular head that can most easily sustain it. Interestingly, this factor was absolutely independent of both the activities of the lateral pterygoid and the direction of bite force. Consequently. TMI loading can be minimized, by coordinating the activities of the masseter and the anterior portion of the temporalis.

Positional reproducibility of the patient's head normalized by a robotized chair-based automatic head-positioning system, Racs-N

With a view to normalization of the head orientation without the use of a fixation jig for the measurement of jaw movement employing an X-ray television, we have been developing an automatic head-positioning system, Racs-N, consisting of a head-position sensor and a robotized chair. The head position is monitored in 6 degrees of freedom (d.o.f.) by using a position-sensitive detector (PSD) camera-based photostereometry. If they are incorrect, the robotized chair rectifies them automatically by adjusting the position and orientation of the head support in 5 d.o.f. (except the vertical position). The rectified position, however, has a certain margin of error, due to the mobility of the head relative to the head support. To improve this, we employed an iterative correction in that the positioning is repeated until the determined position converges. In experiments employing several subjects, this particular correction was verified to converge by more than six iterations and to be effective for the reduction of head-position errors.

Automatic head positioning system using PSD-equipped camera-based photostereometry and a 5-degree-of-freedom robotized chair: calibration and accuracy verification

In measurements of jaw movements employing an X-ray television, the orientation of the patient's head must be normalized relative to the measuring device. To avoid interferring with natural jaw movements caused by using a positioning jig, we have developed an automatic head positioning system consisting of a head position sensor and a robotized chair. The position and orientation of the head is monitored by detecting the three-dimensional positions of four non-coplanar LED markers mounted on the head, by means of a set of two photoelectronic cameras. If they are incorrect, the head is moved into the required position, using a 5-degree-of-freedom robotized chair. To accomplish this accurately, the positional relations of system components must be determined precisely. This paper proposes a least-square technique of calibrating the relationship between the position sensor and the chair. Consequently, accurate positioning is achieved. Accuracy verification studies revealed that overall positioning errors lay within 2.42 mm and 1.28 degrees with respect to the position and orientation, respectively, if the markers are secured to the head support of the chair.