Error analysis of Raven's Coloured Progressive Matrices in children and adolescents with cerebral palsy

BACKGROUND

Analysis of the errors in the Raven's Coloured Progressive Matrices (RCPM) has been previously performed for children with intellectual disabilities but has not been investigated for those with cerebral palsy (CP). This study aimed to investigate whether the types and positions of errors made by individuals with CP differed from those made by typically developing (TD) controls.

METHODS

Forty-five participants with CP aged 4-18 years and 30 TD children aged 3-9 years underwent RCPM testing. We first compared the RCPM performance and error characteristics between the groups and then examined the association between RCPM and the severity of CP and receptive vocabulary in the CP group.

RESULTS

The results showed that while mean total scores in the two groups were comparable, the types and positions of errors made by individuals with CP differed from those of TD controls. The development of non-verbal intelligence in children with CP increased with age; when controlling for age, non-verbal intelligence was significantly correlated with all three functional levels of CP severity and receptive vocabulary.

CONCLUSIONS

This study provides valuable insights into the problem-solving strategies employed by children with CP.

Post COVID-19 condition of the Omicron variant of SARS-CoV-2

Objectives

To investigate the prevalence of post coronavirus disease (COVID-19) condition of the Omicron variant in comparison to other strains.

Study design

A single-center cross-sectional study.

Methods

Patients who recovered from Omicron COVID-19 infection (Omicron group) were interviewed via telephone, and patients infected with other strains (control group) were surveyed via a self-reporting questionnaire. Data on patients’ characteristics, information regarding the acute-phase COVID-19, as well as presence and duration of COVID-19-related symptoms were obtained. Post COVID-19 condition in this study was defined as a symptom that lasted for at least 2 months, within 3 months of COVID-19 onset. We investigated and compared the prevalence of post COVID-19 condition in both groups after performing propensity score matching.

Results

We conducted interviews for 53 out of 128 patients with Omicron and obtained 502 responses in the control group. After matching cases with controls, 18 patients from both groups had improved covariate balance of the factors: older adult, female sex, obesity, and vaccination status. There were no significant differences in the prevalence of each post COVID-19 condition between the two groups. The number of patients with at least one post COVID-19 condition in the Omicron and control groups were 1 (5.6%) and 10 (55.6%) (p = 0.003), respectively.

Conclusions

The prevalence of post Omicron COVID-19 conditions was less than that of the other strains. Further research with a larger sample size is needed to investigate the precise epidemiology of post COVID-19 condition of Omicron, and its impact on health-related quality of life and social productivity.

Adherence to personal protective equipment use among nurses in Japanese tertiary care hospitals: what determines variability?

BACKGROUND

Though nurses have frequent contact with patients, their personal protective equipment (PPE) compliance rate is low, which poses a significant challenge in infection control.

AIM

To investigate the relative influence of specific factors on PPE compliance.

METHODS

A sequential two-stage mixed-methods design was applied. In a qualitative study, semi-structured interviews were conducted from May to July 2018. In a quantitative study, a nationwide, cross-sectional survey was conducted from January to March 2019, in which a questionnaire was mailed to 735 nurses in 28 tertiary care hospitals in Japan.

FINDINGS

In the quantitative study, 435 (59.2%) analysable responses were obtained. In the linear regression analysis, the lack of the knowledge that 'standard precaution was the fundamental infection countermeasure applied when patients had signs of infections, and these countermeasures could be terminated if there was no infection found' was significantly associated with decreased PPE adherence, whereas an antimicrobial-resistant bacteria outbreak or a ward shutdown due to an outbreak and the belief 'I must never be the cause of spreading infection' were significantly associated with increased PPE adherence. The β of standard coefficients and t-values of the items were -0.344, -7.784, 0.090, 2.089, 0.088, 2.018, respectively.

CONCLUSION

This survey systematically identified nursing-associated factors that contribute to PPE compliance. As a practical approach to ensure positive outcomes, we suggest educating nurses by providing adequate knowledge on appropriate PPE use and sharing outbreak or ward shutdown experiences.

Locomotor improvement of spinal cord-injured rats through treadmill training by forced plantar placement of hind paws

STUDY DESIGN

Experimental training model of rats with spinal cord injury (SCI).

SETTING

Osaka, JapanObjective:To investigate the effect of forced treadmill training by plantar placement (PP), as compared with dorsal placement (DP), of the dorsal paws on the locomotor behaviors of spinal cord-injured rats.

METHODS

The spinal cord was contusion-injured at the thoracic level. Rats were divided into three groups: forced training involving stepping by PP and DP and non-forced training/assistance (nT). Training began 1 week after injury and was conducted for 4 weeks. Locomotor behaviors were estimated using Basso-Beattie-Bresnahan (BBB) scores, dorsiflexion of the hind paws and footprints of the hind paws. Histological and immunohistochemical examinations of the spinal cord lesions were conducted after 4 weeks of training.

RESULTS

The values, respectively, of PP, DP and nT groups at 4 weeks of training were as follows: BBB scores were 15.6±0.8, 7.7±1.3 and 10.3±0.4. The paw dorsiflexion angles were 34.1±5.2, 16.4±2.4 and 23.6±3.0 degrees, respectively. The stride angles were 5.1±0.9, 13.7±4.9 and 17.8±4.0 degrees for the left paws. Cavity volumes were 10.3±2.1, 31.0±2.0 and 28.2±4.9%. In addition to cavities, there were astrocyte-devoid areas containing some loose tissues, through which many axons extended longitudinally.

CONCLUSIONS

The BBB score, dorsiflexion angle and stride angle were consistently improved in the PP group. Cavity formation was more reduced, and many axons extended through coarse tissues formed in astrocyte-devoid areas at the lesion in the PP group. Forced training by PP of the hind paws promoted the behavioral and histological improvement of rats with SCI.

Effect of 5-hydroxytryptamine receptor 4 agonist mosapride on human gastric accommodation

BACKGROUND

Impaired gastric accommodation is one of the major features of functional dyspepsia. Mosapride citrate is a 5-hydroxytryptamine receptor 4 (5-HT4) agonist, which is shown to improve upper abdominal symptoms. However, effect of mosapride on gastric accommodation was not clear. We tested the hypothesis that mosapride enhances the gastric accommodation in normal individuals.

METHODS

Fourteen male healthy volunteers completed this study. Single administration of mosapride or placebo was performed randomly with more than 1-week interval. Subjects swallowed a triple-lumen polyvinyl tube with a polyethylene bag. The bag was positioned in the proximal stomach and the minimal distending pressure (MDP) was determined. The ramp distension starting from the MDP was then performed and subjects were instructed to score their perception using ordinate scales. Next the intra-bag pressure was set at MDP + 2 mmHg and a liquid meal was administered 30 min later, and the intra-bag volume was recorded for 60 min. We compared the MDP, perception scores, and the intra-bag volume changes by administering placebo and mosapride.

KEY RESULTS

Minimal distending pressure was not significantly different in subjects receiving mosapride or placebo. Treatment with mosapride had no effect on intra-bag pressures or volumes inducing first sensation or discomfort. Gastric accommodation, expressed as the difference between pre- and postmeal intra-bag volumes, and the percent change of the intra-bag volumes by the meal was significantly enhanced by mosapride compared with placebo.

CONCLUSIONS & INFERENCES

This is the first study clearly demonstrating that single administration of 5-HT4 agonist can enhance gastric accommodation in humans. (Umin.ac.jp, number UMIN000014063).

Effects of Changes of Foot Position on Romberg's Quotient of Postural Sway and Leg Muscles Electromyographic Activities in Standing

Changing of standing position and visual blocking methods have been used as a convenient evaluation of standing balance by physical therapists. The purpose of this study was to investigate the effects of changes of foot positions on Romberg's quotient of postural sway and the tibialis anterior and gastrocnemius muscles activities in standing for normal men. Subjects were 45 college students. For the measurement of muscles activities, 15 subjects were selected at random from among the 45 students. The standing positions were standing with legs 10 cm apart, standing with legs together, tandem standing, standing on tiptoes, and standing on one leg with the eyes open and closed. Measurements were made using a center of foot pressure recorder and surface electromyography for 30 seconds. Romberg's quotient and the relative muscle activities of the leg were both found to be in the order standing with legs apart, standing with legs together, tandem standing, standing on tiptoes, standing on one leg. It has conventionally been considered that the instability of postural sway is increased when vision is blocked. The present results suggested that postural regulation by the physiological subsystem is indirectly affected by vision and somatosensory input.

Altered cerebellum development and dopamine distribution in a rat genetic model with congenital hypothyroidism

Thyroid hormones play crucial roles in the development and functional maintenance of the central nervous system. Despite extensive studies of the neural function of thyroid hormones, little is known about the effects of hypothyroidism on behavioural traits and the mechanisms underlying such effects. In the present study, we report an investigation of congenitally hypothyroid mutant rdw rats, revealing a novel function of thyroid hormones in the central nervous system. The rdw rats were subjected to behavioural analyses such as the rotarod test, open field test and circadian activity measurement. To determine the cause of behavioural disorders, cerebellar morphogenesis was examined by immunohistochemical analysis, and the axonal transport of dopamine in the nigrostriatal pathway was analysed by high-performance liquid chromatography and western blotting. The effects of thyroxine administration to the rdw rats were examined by behavioural analysis. The rdw rats showed severe impairment of motor coordination and balance. This could be explained by the fact that the rats showed severe retardation of cerebellar morphogenesis, which correlates with the small somata and poor dendritic arborisation of Purkinje cells and retarded migration of granule cells particularly during the first two postnatal weeks. Moreover, the rdw rats showed hypoactivity, characterised by decreased circadian locomotor activity. After weaning, thyroxine administration improved the dwarfism in rdw rats but had no effect on cerebellar function. In addition, the rdw rats showed anxiety and depression intrinsically to novel surroundings. Interestingly, the rdw rats showed high levels of dopamine in the substantia nigra and low levels in the striatum, an important centre for the coordination of behaviour. Furthermore, low levels of tubulin in the striatum were detected, indicating the aberrant axonal transport of dopamine in the nigrostriatal pathway as a result of the reduced delivery of microtubules. These findings indicate an important function of thyroid hormones in cerebellar formation and in the regulation of axonal transport of dopamine. Moreover, rdw rats will be useful for studies of brain function and behavioural disorders in congenital hypothyroidism.

Snapping pes syndrome after total knee arthroplasty

Snapping syndrome rarely occurs at the knee joint. This is the first report of snapping pes syndrome after total knee arthroplasty. Surgeons should be aware of the presence of such a case and pay attention to the fact that snapping symptoms could be caused by a residual bony prominence and a change in alignment after total knee arthroplasty.

A case of steroid-resistant nephrotic syndrome associated with systemic lupus erythematosus

We report on an 11-year-old girl who developed steroid-resistant nephrotic syndrome (NS) at the onset of systemic lupus erythematosus (SLE), and clinical and renal histological findings suggested that her NS would be associated with SLE-related podocytopathy. Although initial treatment with intravenous pulse methylprednisolone was ineffective, following treatment with cyclosporine and an angiotensin receptor blocker was effective for her nephrotic proteinuria. She had developed posterior reversible encephalopathy syndrome (PRES), and mycophenolate mofetil (MMF) was started instead of cyclosporine. At present, 45 months after the onset, she is in remission of both NS and SLE. This case indicates that NS associated with SLE-related podocytopathy should be included in the spectrum of glomerulopathy accompanying SLE, also in the pediatric population.

Gravitational unloading inhibits the regenerative potential of atrophied soleus muscle in mice

AIM

The present study was performed to investigate the influence of unloading on the regeneration of atrophied and injured skeletal muscle.

METHODS

Male mice (C57BL/6J), aged 8 weeks, were used. Cardiotoxin (CTX) was injected into soleus muscles bilaterally. Gravitational unloading on soleus muscle was performed by hind limb suspension for 2 weeks before and additionally 6 weeks after CTX injection in one group. Soleus muscles in the remaining groups were loaded keeping the mice in the cages and were dissected 14, 28 and 42 days after the injection.

RESULTS

Recovery of the wet weight and protein content of soleus in the CTX-injected group was inhibited by unloading. Increase in satellite cell number, induced by CTX injection and loading, was also inhibited by unloading. Disappearance of infiltration of mononucleated cells into the necrotic area was also delayed. This phenomenon suggests that regeneration, which is indicated by the appearance of fibres with central nuclei, was inhibited by unloading.

CONCLUSION

Results suggested that loading plays an important role in the activation of the regenerating potential of injured skeletal muscle.

TAK1 kinase determines TRAIL sensitivity by modulating reactive oxygen species and cIAP

TNF-related apoptosis-inducing ligand (TRAIL) is a potent inducer of cell death in several cancer cells, but many cells are resistant to TRAIL. The mechanism that determines sensitivity to TRAIL-killing is still elusive. Here we report that deletion of TAK1 kinase greatly increased activation of caspase-3 and induced cell death following TRAIL stimulation in keratinocytes and fibroblasts as well as cancer cells. Although TAK1 kinase is involved in NF-κB pathway, ablation of NF-κB did not alter sensitivity to TRAIL. We found that TRAIL could induce accumulation of reactive oxygen species (ROS) when TAK1 was deleted. Furthermore, we found that TAK1 deletion induces TRAIL-dependent downregulation of cIAP, which enhances activation of caspase-3. These results demonstrate that TAK1 deletion facilitates TRAIL-induced cell death by activating caspase through ROS and downregulation of cIAP. Thus, inhibition of TAK1 can be an effective approach to increase TRAIL sensitivity.

Phenomenological viscous factor in the nonequilibrium distribution function for liquids

An improved formula of shear viscosity for liquids is presented by introducing a phenomenological viscous factor in the nonequilibrium term in the doublet distribution function, which improves an incomplete formula of shear viscosity presented in an early work of Born and Green. The phenomenological viscous factor effectively counts some higher-order interactions, and is constrained so that, in the limit of hard-sphere liquids, the magnitude of the improved formula of shear viscosity reduces to that of Enskog for dense fluids. The improved formula does not require any adjustable parameters except for the pair potential to describe liquids. In order to verify the improved formula, a liquid of Ar near the triple point is studied in detail. In addition, liquids of Pb in wide ranges of temperature are examined to test the temperature dependence of the phenomenological viscous factor. Here an available integral equation is employed to calculate the radial distribution function by prescribed pair potentials. One finds that the present formula is capable to describe the shear viscosity in accord with those of experimental data for both cases of Ar and Pb. The phenomenological viscous factor plays a crucial role in the evaluation of shear viscosity for liquids.

Mg-dechelation activity in radish cotyledons with artificial and native substrates, Mg-chlorophyllin a and chlorophyllide a

The Mg-dechelation activity in extracts from radish (Raphanus sativus L.) cotyledons was investigated using an artificial substrate, Mg-chlorophyllin a (Chlin) and the native substrate, chlorophyllide a (Chlide). In addition to a known a small molecular weight metal-chelating substance (MCS), Mg-releasing protein (MRP) was present when Chlin was used as the substrate. However, only MCS had Mg-dechelation activity with the native substrate. To examine the possibility of the dissociation of MRP into a protein moiety and a small molecular mass compound with an activity like MCS, extraction with low and high ionic strength buffers was carried out. No evidence was obtained that MCS is a moiety of MRP, however. Inhibitor studies showed that MCS and MRP had different susceptibilities to the inhibitors, especially to the chelators tiron and EDTA when Chlin was used as the substrate. Tiron had no effect on MRP, but it severely reduced MCS activity in both substrates. The activity of MRP increased during senescence, indicating the induction of MRP, while the activity of MCS was almost unchanged. These results suggest different reaction mechanisms by independent compounds. These findings suggest that MRP and MCS are present independently, and MCS is postulated to be a substance that catalyzes the Mg-dechelation reaction in the breakdown pathway of Chl, although MCS was not induced during senescence. The properties of MRP and MCS in relation to the small molecular mass substance obtained from strawberry fruit are also discussed.

Comparison of left atrial size by freehand scanning three-dimensional echocardiography and two-dimensional echocardiography

AIMS

As the left ventricular (LV) dimension is a poor indicator of LV volume, there are well-known limitations of left atrial (LA) antero-posterior dimensions as indicators of chamber size. LA volume has been shown to provide a more accurate assessment of LA size than LA dimension. To evaluate two-dimensional (2D)-derived LA volume in assessing LA size, we compared LA dimension and 2D LA volume with three-dimensional (3D)-derived LA volume.

METHODS

We performed transthoracic freehand scanning 3D echocardiography (3D EchoTech, Germany) using magnetic fields and a harmonic imaging system in 32 patients. We collected a series of LA tomograms by slowly tilting the probe (fan-like scanning) in the parasternal position. The 3D LA volume was calculated by using the multiplanar Simpson's method. The 2D LA volume was measured by using the modified biplane Simpson's rule.

RESULTS

LA antero-posterior dimensions and 2D volumes showed a significant positive correlation with 3D LA volumes. However, the correlation coefficient was significantly greater for the relationship between 2D LA volumes and 3D LA volumes than for that between LA dimensions and 3D LA volume.

CONCLUSIONS

The 2D LA volumes provide a more accurate measure of the true size of the LA and are more sensitive to changes in LA size.

Quantitative assessment of harmonic power Doppler myocardial perfusion imaging with intravenous Levovist in patients with myocardial infarction: comparison with myocardial viability evaluated by thallium-201 single-photon emission computed tomography and coronary flow reserve

BACKGROUND

Intravenous myocardial contrast echocardiography with harmonic power Doppler imaging is a novel technique for assessing myocardial perfusion.

AIMS

The aim of this study was to quantitatively assess myocardial perfusion by harmonic power Doppler imaging in patients with a previous myocardial infarction and compare myocardial contrast echocardiography results with myocardial viability evaluated by thallium-201 single-photon emission computed tomography ((201)Tl-SPECT) and the results of Doppler flow measurement of coronary flow velocity reserve.

METHODS

Twenty-three patients with anterior myocardial infarction who were scheduled for adenosine stress (201)Tl-SPECT underwent myocardial contrast echocardiography with harmonic power Doppler imaging. Harmonic power Doppler imaging was performed at rest and during adenosine infusion (0.15 mg/kg/min) using an intravenous infusion of Levovist. The peak colour pixel intensity ratios of the risk area to the control area were used for quantitative analysis of myocardial perfusion by harmonic power Doppler imaging. Coronary blood flow velocity was measured using Doppler-tipped guidewire in the distal portion of left anterior descending artery and coronary flow velocity reserve was calculated.

RESULTS

In patients with myocardial viability assessed by (201)Tl-SPECT, pixel intensity ratios both at rest and during hyperaemia were significantly higher compared with those in patients without myocardial viability (at rest: 0.62 +/- 0.28 vs 0.37 +/- 0.17, P=0.038, during hyperaemia 0.72 +/- 0.19 vs 0.40 +/- 0.18, P=0.003). Coronary flow velocity reserve was significantly different between two groups (2.35 +/- 0.43 vs 1.49 +/- 0.53, P <0.01).

CONCLUSIONS

Quantitative assessment of microvascular integrity by harmonic power Doppler imaging corresponds to the evaluation of the microcirculation by coronary flow velocity reserve.

Bone loss at the lumbar spine and the proximal femur in a rural Japanese community, 1990-2000: the Miyama study

Bone mineral density (BMD) was measured over a ten year period in a cohort study in Miyama village, Wakayama Prefecture, Japan, to provide information on rate of bone loss in the mature and elderly population. Four hundred subjects were selected by sex and age decade from the full list of residents born in 1910-1949, and aged 40-79 years at the end of 1989, with 50 men and 50 women in each age decade. Baseline BMD of the lumbar spine and the proximal femur was measured using dual energy X-ray absorptiometry (DXA) in 1990 and again in 1993, 1997 and 2000. Annual rate of change in BMD (% per year) in the lumbar spine in men in their forties, fifties, sixties and seventies was 0.17, 0.55, 0.01 and -0.16, respectively, and in women, -0.87, -0.83, -0.48 and -0.48, respectively. Thus in men, BMD at the lumbar spine increased in all age strata but the oldest, when it decreased, whereas in women, it decreased in all age strata. On the other hand, BMD at the proximal femur decreased in both sexes in all age strata. Our results show that bone loss rates differ depending on the site involved, demonstrating that different strategies are needed for the prevention of bone loss in the spine and hip.Furthermore, we found evidence of differences in BMD for given age strata between birth cohorts. Data in 1990 and in 2000 showed significant improvements for men in their sixties and for women in their fifties, suggesting that future problems of osteoporosis might be less severe than has previously been predicted in Japan.

[Incidence of systolic pulmonary venous flow reversal in patients with mitral valve prolapse: influence of the prolapse site]

OBJECTIVES

Systolic pulmonary venous flow reversal identified by pulsed Doppler echocardiography is useful for the diagnosis of severe mitral regurgitation. The direction of the mitral regurgitant jet in severe mitral regurgitation significantly influences the systolic pulmonary venous flow reversal in an experimental model. This study investigated the influence of the site of mitral valve prolapse on the incidence of systolic pulmonary venous flow reversal in patients with severe mitral regurgitation using transthoracic color Doppler echocardiography.

METHODS

This study included 59 consecutive patients with severe mitral regurgitation (regurgitant fraction > 50%) due to mitral valve prolapse. Exclusion criteria were left ventricular ejection fraction < 45%, non sinus rhythms, associated aortic valve disease, bileaflet prolapse, and inadequate Doppler recordings. Right upper pulmonary venous flow was recorded and regurgitant fraction of mitral regurgitation measured by transthoracic color Doppler echocardiography. The sites of mitral valve prolapse were confirmed at operation in all patients.

RESULTS

The incidence of systolic pulmonary venous flow reversal was 78% (14/18) in the patients with anterior leaflet prolapse, 82% (9/11) in the patients with medial commissure prolapse, 75% (12/16) in the patients with posterior middle scallop prolapse, 20% (2/10) in the patients with posterior medial scallop prolapse, and 25% (1/4) in the patients with posterior lateral scallop prolapse. There were no significant differences in regurgitant fraction between the five groups. The incidence of systolic pulmonary venous flow reversal was significantly lower in the patients with posterior medial scallop prolapse compared to the other sites of mitral valve prolapse (p < 0.01).

CONCLUSIONS

Assessment of the severity of mitral regurgitation by systolic pulmonary venous flow reversal using transthoracic color Doppler echocardiography may be underestimated in patients with prolapse of the posterior medial scallop.

Comparative effects of all-trans beta-carotene vs. 9-cis beta-carotene on carcinogen-induced neoplastic transformation and connexin 43 expression in murine 10T1/2 cells and on the differentiation of human keratinocytes

9-cis beta-Carotene was extracted from a commercial extract of the algae Dunaliella salina (Betatene), and its actions on proliferation and gene expression were examined in murine 10T1/2 cells and human HaCaT keratinocytes. The 9-cis isomer was less active than all-trans beta-carotene in reducing proliferation and in upregulating expression of connexin 43 in 10T1/2 cells. However, it had comparable ability to suppress carcinogen-induced neoplastic transformation. When tested in HaCaT cells in organotypic culture, it was less active in inducing connexin 43 expression and suppressing expression of keratin K1. In this assay the all-trans isomer was highly active at 10(-6) M, whereas 10(-5) M 9-cis beta-carotene was required to produce a comparable effect. Only small reductions in expression of the basal keratin 5 were seen. All-trans and 9-cis retinoic acids, potential metabolites of beta-carotene isomers, were studied in the same systems. In contrast to the carotenoids, the 9-cis isomer of retinoic acid was approximately 10-fold more active in suppressing neoplastic transformation and inducing connexin 43 expression in both cell types than the all-trans isomer. The retinoic acid isomers were about equipotent in suppressing K1 expression. Cellular levels of 9-cis beta-carotene were approximately 3.5-fold lower than levels of all-trans beta-carotene, suggesting that part, but not all, of this decreased activity of the 9-cis isomer was due to decreased cell uptake. Thus 9-cis beta-carotene is consistently less active than the all-trans isomer; that 9-cis retinoic acid is, in general, much more potent than the all-trans isomer suggests little or no conversion from the carotenoid to the retinoid under these culture conditions.

[A case of isoniazid-resistant tuberculosis diagnosed during chemoprophylaxis with isoniazid]

A 15-year-old man, who was a classmate with the index case of a large outbreak of tuberculosis in a junior high school in Kochi city, showed strongly positive reaction to tuberculin skin test in March 1999. After taking a chest X-ray film, which showed no abnormal finding, chemoprophylaxis with isoniazid was started in April 1999. He was compliant with therapy, and had no symptom until July 1999, when he was checked again by chest X-ray and abnormal finding was suspected. He visited a hospital for further examinations, and chest X-ray revealed cavitary lesion and sputum smears showed acid-fast baccili. Cultures of the sputum was positive for Mycobacterium tuberculosis, and drug susceptibility tests revealed that the organism was resistant to isoniazid (5 micrograms/ml) and sensitive to RFP, SM, and EB. RFLP analysis of Mycobacterium tuberculosis isolated from the index-case patient and the present patient demonstrated an identical pattern, although the organism obtained from the index-case patient was sensitive to isoniazid, RFP, SM, and EB. Mycobacterium tuberculosis isolated from other 7 patients in the same outbreak showed an identical pattern in RFLP analysis and were also sensitive to isoniazid. The present patient was a close contact with the highly infectious index-case patient. The patient was estimated to be infected around September to October, 1998, and chemoprophylaxis with isoniazid was started in April 1999, when the tubercle baccili had grown considerably, but not enough to show radiographic abnormality. These two factors might be attributable to rarely seen development of isoniazid resistance in this case.

[Three-dimensional transesophageal echocardiographic measurement of left ventricular volumes using the average rotation method: comparison with the disk summation method]

OBJECTIVES

Three-dimensional(3-D) echocardiography accurately calculates left ventricular volumes without geometric assumptions. Conventional 3-D echocardiography using the disk summation method is limited in practical use because of the long analysis time. This study validated the average rotation method for rapid and accurate left ventricular volume measurement compared with the conventional disk summation method.

METHODS

3-D data acquisition using multiplane transesophageal echocardiography was performed in 13 patients. Left ventricular volumes and ejection fraction were calculated by the disk summation method with 20 parallel short-axis tomograms and by the average rotation method with 3, 6, 9 and 12 apical long-axis tomograms.

RESULTS

3-D left ventricular volumes and ejection fraction by the average rotation method in each subgroup of slice resolution had excellent correlation and close limits of agreement with those by the disk summation method. Intraobserver variability and interobserver variability were < or = 11%. With the use of three component tomograms, analysis time required for left ventricular volume measurement by the average rotation method was < or = 2 min.

CONCLUSIONS

Transesophageal 3-D echocardiography using the average rotation method is a clinically useful tool for accurate and rapid measurement of left ventricular volume and function.

[Tuberculosis outbreak in a junior high school in Kochi City--studies on factors relating to extent of tuberculosis infection and the efficacy of isoniazid chemoprophylaxis]

A 15-year-old girl, third-grade student of a junior high school (the index case) was found to have smear-positive, cavitary pulmonary tuberculosis. Contact investigation was conducted, including tuberculin skin test and chest X-ray examinations over 700 persons. Tuberculin skin test revealed an excess of strongly-positive reactors in the third-grade students. During 2 years after the detection of the index case, a total of 31 tuberculosis patients were newly diagnosed, and out of them 8 were culture positive and restriction fragment length polymorphism (RFLP) analysis of the 8 strains and that of the index case demonstrated an identical pattern. A delay in diagnosis of the index case and poor ventilation of the classrooms were attributable to this rather large outbreak. In addition the source case seems to be highly infectious, because transmission following only sporadic contact was documented. Among the third-grade students and school staff, 129 persons were strongly-positive reactors to tuberculin skin test. Out of them one hundred five persons completed isoniazid chemoprophylaxis of recommended six months, and the others didn't receive chemoprophylaxis because most of them were aged above 30 years. All of them were followed up for 2 years after the detection of the index case, and out of 105 persons who received chemoprophylaxis, 2 cases (1.9%) were newly diagnosed as tuberculosis, while out of 24 persons without chemoprophylaxis, 6 cases (25%) developed tuberculosis.

Validity and reliability of single-item questions about physical activity

The Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study) included in its self-administered questionnaires some single-item questions concerning physical activity. We examined the validity of the questions among 1,730 Japanese adults and the reliability of the questions among 1,075 Japanese adults. The validity of the sports and physical exercise questions was estimated by comparing the self-administered questionnaire responses with the time spent on the activity and the energy expenditure index for the previous 12-month period, elicited by the interviewing method used in the Japan Lifestyle Monitoring Study with a minor modification. The Spearman's rank correlation coefficients ranged from 0.43 to 0.60, showing moderate correlations. On the other hand, test-retest reliability was estimated by comparing the responses from two separate surveys conducted roughly one year apart. Weighted kappa coefficients of sports and physical exercise questions, classified according to sex and age, ranged from 0.39 to 0.56, showing moderate reliability; and those of a question about walking ranged from 0.25 to 0.39, showing fair reliability. We suggest that measuring physical activity level with these single-item questions may be appropriate for establishing baseline data that reflects long-term physical activity in a large-scale cohort study targeting lifestyle-related diseases.

Identification of cardiac abnormal structures with harmonic power Doppler contrast echocardiography

We describe two cases in which echocardiographic image enhancement with an intravenous contrast agent using harmonic power Doppler (HPD) imaging established the diagnosis of abnormal structures in the left ventricle (LV).

Japanese and Western diet and risk of idiopathic sudden deafness: a case-control study using pooled controls

BACKGROUND

One of the proposed aetiological mechanisms for idiopathic sudden deafness is vascular disease. However, it is not known whether traditional cardiovascular risk factors, such as particular dietary factors, are associated with this condition.

METHODS

A case-control study using pooled controls was conducted in Japan to investigate the relationship between idiopathic sudden deafness and diet. An m:n matched-pairs method was used to obtain age-, gender- and residential district-matched controls from a nationwide database of pooled controls. Food intake was assessed from a self-administered usual food frequency questionnaire that asked about intake of 35 foods (including four drinks). Participants were classified according to the frequency of intake of Western foods and the frequency of intake of traditional Japanese foods. Subgroup analyses were performed using audiometric subtypes of idiopathic sudden deafness.

RESULTS

Data were obtained for 164 cases and 20,313 controls. An increased risk of sudden deafness was observed among participants who frequently consumed Western foods (OR = 1.82, 95% CI : 1.14--2.89), and a decreased risk of this condition was observed among participants who frequently consumed Japanese foods (OR = 0.52, 95% CI : 0.33--0.82). A direct association of sudden deafness with Western food intake was evident for flat-type hearing loss.

CONCLUSIONS

This study suggests that a largely Western diet might be a risk factor for idiopathic sudden deafness, a traditional Japanese diet might be a preventive factor for this condition, or both. These findings are consistent with the hypothesis that vascular factors are an important cause of idiopathic sudden deafness, although the possibility of residual confounding by unmeasured confounders such as socioeconomic status cannot be ruled out.

Smoking, alcohol, sleep and risk of idiopathic sudden deafness: a case-control study using pooled controls

Sudden deafness sometimes has an identifiable cause, but in most cases the cause is unknown (idiopathic sudden deafness). Vascular impairment has been proposed as an aetiological mechanism for this condition, but it is unclear whether traditional cardiovascular risk factors, such as smoking or alcohol intake, are associated with this condition. We accordingly investigated associations of idiopathic sudden deafness with smoking, alcohol intake and sleep duration in a case-control study. Cases were consecutive patients diagnosed with idiopathic sudden deafness between October 1996 and August 1998 at collaborating hospitals in Japan. Controls were obtained from a nationwide database of pooled controls, with matching for age, gender and residential district. Exposure variables were assessed from a self-administered questionnaire. Subgroup analyses were performed using audiometric subtypes of sudden deafness. Data were obtained for 164 cases and 20,313 controls. Increased risks of idiopathic sudden deafness were observed among participants who consumed two or more units of alcohol per day (OR=1.90, 95% CI=1.12-3.21), and among participants who slept less than seven hours per night (OR=1.61, 95% CI=1.09-2.37). The direct association with alcohol intake was particularly strong for the participants with profound hearing loss. There was little evidence of an association with smoking. This study suggests that alcohol intake and short sleep duration might be risk factors for idiopathic sudden deafness.

Troglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with non-insulin dependent diabetes mellitus: a serial intravascular ultrasound study

OBJECTIVES

The aim of the present study was to determine whether troglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with non-insulin dependent diabetes mellitus (NIDDM).

BACKGROUND

Increased in-stent restenosis in patients with diabetes mellitus is due to accelerated neointimal tissue proliferation after coronary stent implantation. Troglitazone inhibits intimal hyperplasia in experimental animal models.

METHODS

We studied 62 stented lesions in 52 patients with plasma glucose levels (PG) > or = 11.1 mmol/liter at 2 h after 75 g oral glucose load. The study patients were randomized into two groups: the troglitazone group of 25 patients with 29 stents, who were treated with 400 mg of troglitazone, and the control group of 27 patients with 33 stents. All patients underwent oral glucose tolerance tests before and after their six-month treatment period. The sum of PG (sum of PG) and the sum of insulin levels (sum of IRI) were measured. Serial (postintervention and at six-month follow-up) intravascular ultrasound studies were performed. Cross-sectional images within stents were taken at every 1 mm, using an automatic pullback. Stent areas (SA), lumen areas (LA), and intimal areas (IA = SA - LA) were measured and averaged over a number of selected image slices. The intimal index was calculated as intimal index = averaged IA/averaged SA x 100%.

RESULTS

There were no differences between the two groups before treatment in sum of PG (31.35 +/- 3.07 mmol/liter vs. 32.89 +/- 4.87 mmol/liter, respectively, p = 0.2998) and sum of IRI (219.6 +/- 106.2 mU/liter vs. 209.2 +/- 91.6 mU/liter, respectively, p = 0.8934). However, reductions in sum of PG at the six-month follow-up in the troglitazone group were significantly greater than those in the control group (-21.4 +/- 8.8% vs. -4.5 +/- 7.4%, respectively, p < 0.0001). Likewise, decreases in sum of IRI were greater in the troglitazone-treated group (-31.4 +/- 17.9% vs. -1.9 +/- 15.1%, respectively, p < 0.0001). Although, there were no differences between the two groups in SA at postintervention (7.4 +/- 2.2 mm2 vs. 7.3 +/- 1.7 mm2, respectively, p = 0.9482) and at follow-up (7.3 +/- 2.3 mm2 vs. 7.3 +/- 1.8 mm2, respectively, p = 0.2307), the LA at follow-up in the troglitazone group was significantly greater than that in the control group (5.3 +/- 1.7 mm2 vs. 3.7 +/- 1.7 mm2, respectively, p = 0.0002). The IA at follow-up in the troglitazone group was significantly smaller than that in the control group (2.0 +/- 0.9 mm2 vs. 3.5 +/- 1.8 mm2, respectively, p < 0.0001). This was also true for intimal index (27.1 +/- 11.5% vs. 49.0 +/- 14.4%, respectively, p < 0.0001).

CONCLUSIONS

Serial intravascular ultrasound assessment shows that administration of troglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with NIDDM.

Hyperinsulinemia during oral glucose tolerance test is associated with increased neointimal tissue proliferation after coronary stent implantation in nondiabetic patients: a serial intravascular ultrasound study

OBJECTIVES

The purpose of this study was to determine whether hyperinsulinemia during the oral glucose tolerance test is associated with increased neointimal tissue proliferation after coronary stent implantation in nondiabetic patients.

BACKGROUND

Although hyperinsulinemia induces increased vascular smooth muscle cell proliferation in experimental models, it has not been determined whether hyperinsulinemia is associated with increased neointimal tissue proliferation after coronary stent implantation.

METHODS

Serial (postintervention and six-month follow-up) intravascular ultrasound (IVUS) was used to study 67 lesions treated with Palmaz-Schatz stents in 55 nondiabetic patients. Cross-sectional images within stents were taken at every 1 mm, using an automatic pullback, and a neointimal index was calculated as the ratio between the averaged neointimal area and averaged stent area. All patients underwent a 75-g oral glucose tolerance test. Plasma glucose (PG) and immunoreactive insulin (IRI) levels were measured at baseline and 1 and 2 h after the glucose load. The sum of PGs (sigmaPG) and the sum of IRIs (sigmaIRI) were calculated. Body mass index (BMI), lipid levels, and glycosylated hemoglobin levels were measured.

RESULTS

There were 27 patients with normal glucose tolerance, and 28 patients with impaired glucose tolerance (IGT). The neointimal index in patients with IGT was greater than that in patients with normal glucose tolerance (42.9 +/- 14% vs. 24.9 +/- 8.3%, respectively, p < 0.0001). Linear regression analysis showed that the neointimal index at follow-up correlated well with sigmaPG (p < 0.0001), fasting IRI (p < 0.0001), sigmaIRI (p < 0.0001), triglyceride level (p = 0.018), and BMI (p < 0.0001). Multiple regression analysis revealed that sigmaIRI (p = 0.0002) and sigmaPG (p = 0.0034) were the best predictors of the greater neointimal index at follow-up.

CONCLUSIONS

Serial IVUS assessment shows that hyperinsulinemia during an oral glucose tolerance test is associated with increased neointimal tissue proliferation after coronary stent implantation in nondiabetic patients.

[Measurement of left ventricular filling by automated contour tracking method in echocardiography: comparison with radionuclide ventriculography]

Recent development of an automated contour tracking (ACT) method using the energy minimization principle provides automated edge detection and tracking of the endocardial boundary of the left ventricle, without tracing a region of interest. This study determined whether left ventricular filling indexes obtained from the ACT method provide a reliable estimate of left ventricular diastolic filling. Fourteen patients were examined by the ACT method and equilibrium radionuclide ventriculography. The volume-time wave form for ACT measurements was obtained from the 4-chamber views. Peak filling rate and time to peak filling rate measured by the ACT method were compared with those determined by radionuclide ventriculography. Peak filling rate and time to peak filling rate by the ACT method were closely correlated with those determined by radionuclide ventriculography (peak filling rate: r = 0.88, y = 0.71x + 0.36, SEE = 0.54 ml/end-diastolic volume/sec, time to peak filling rate: r = 0.89, y = 0.72x + 30.0, SEE = 0.02 msec, respectively) The ACT method is useful for the assessment of left ventricular diastolic filling.

Biochemical markers of bone turnover and bone loss at the lumbar spine and femoral neck: the Taiji study

The purpose of this study was to ascertain whether biochemical markers of bone turnover predict bone loss. The survey was carried out in Taiji, Wakayama Prefecture, Japan. From a list of inhabitants aged 40-79 years, 400 participants (50 men and 50 women in each of four age groups) were selected randomly. Bone mineral density (BMD) was measured, and blood and urine samples of all participants were examined to obtain values for eight biochemical markers: alkaline phosphatase (ALP), bone Gla protein (BGP), type I procollagen (carboxyterminal peptide of type I procollagen; PICP), cross-linked carboxyterminal telopeptide region of type I collagen (ICTP), and urinary excretion of calcium (Ca), phosphate (P), pyridinoline (Pyr), and deoxypyridinoline (D-Pyr). Each marker was evaluated as a predictor of the rate of bone change in lumbar spine and femoral neck BMD over a 3-year period. The value of Pyr was significantly related to the change of lumbar spine BMD in men (P = 0.009), and that of BGP was found to be significant in women (P = 0.045). By contrast, none of the bone markers significantly correlated with bone loss at the femoral neck. The coefficient of determination at the lumbar spine was 5% and 7% at the femoral neck only. We conclude that biochemical markers of bone turnover cannot predict bone loss rates in middle-aged or elderly Japanese men and women over a 3-year period with sufficient accuracy for use in clinical decision making.

A probable relationship between an endogenous digitalis-like substance and concentric cardiac hypertrophy in primary aldosteronism

A 44-year-old woman was admitted to our hospital due to severe hypertension. An electrocardiogram (ECG) and an echocardiogram showed severe left ventricular hypertrophy. Her plasma aldosterone level was elevated. Magnetic resonance imaging revealed a small mass in the right adrenal gland. Before removal of the tumor, plasma endogenous digitalis-like substance (EDLS) levels were elevated. After removal of the tumor, EDLS levels quickly returned to the normal level. A series of echocardiograms and ECGs over a 6- year period after removal of the tumor showed marked regression of cardiac hypertrophy. These findings suggest that EDLS may be closely related to the development of concentric cardiac hypertrophy in primary aldosteronism.

Sublingual nifedipine in elderly patients: even a low dose induces myocardial ischaemia

1. Low doses of sublingual nifedipine are still used for the treatment of hypertensive crises, although recent studies have raised concerns that sublingual nifedipine may cause serious dose-dependent adverse effects. The present study was performed to test the safety of low-dose sublingual nifedipine administered to elderly hypertensive patients. 2. Systemic blood pressure measurements and electrocardiographic (ECG) examinations were performed before and 45-60 min after a 5 mg dose of sublingual nifedipine in 93 consecutive hypertensive patients, 65 years of age or older, who were without coronary artery disease. In 33 patients, the effects of nifedipine on myocardial lactate metabolism were studied during cardiac catheterization. 3. In all patients, following nifedipine administration, blood pressure (BP) decreased significantly, while heart rate (HR) increased, and symptoms associated with elevated BP disappeared. However, changes consistent with myocardial ischaemia appeared on the ECG in six of 55 patients with left ventricular hypertrophy (LVH) and in one of 38 patients without LVH, although only two of these seven patients experienced angina-like precordial tightness. Sublingual nifedipine decreased myocardial lactate extraction from 52 +/- 13 to 38 +/- 19% in 20 patients with LVH (P = 0.02), but myocardial lactate extraction remained stable in 13 patients without LVH (49 +/- 7 to 50 +/- 5%; NS). The change in lactate extraction was significantly correlated with the percentage change in diastolic arterial pressure (r = 0.77, P < 0.001). 4. These results suggest that sublingual nifedipine, even at the low dose of 5 mg, may cause myocardial ischaemia in some elderly patients with LVH that is associated with a marked reduction in coronary perfusion pressure.