Estimating Body Weight From Measurements From Different Single-Slice Computed Tomography Levels: An Evaluation of Total Cross-Sectional Body Area Measurements and Deep Learning

OBJECTIVE

This study aimed to evaluate the correlation between the estimated body weight obtained from 2 easy-to-perform methods and the actual body weight at different computed tomography (CT) levels and determine the best reference site for estimating body weight.

METHODS

A total of 862 patients from a public database of whole-body positron emission tomography/CT studies were retrospectively analyzed. Two methods for estimating body weight at 10 single-slice CT levels were evaluated: a linear regression model using total cross-sectional body area and a deep learning-based model. The accuracy of body weight estimation was evaluated using the mean absolute error (MAE), root mean square error (RMSE), and Spearman rank correlation coefficient ( ρ ).

RESULTS

In the linear regression models, the estimated body weight at the T5 level correlated best with the actual body weight (MAE, 5.39 kg; RMSE, 7.01 kg; ρ = 0.912). The deep learning-based models showed the best accuracy at the L5 level (MAE, 6.72 kg; RMSE, 8.82 kg; ρ = 0.865).

CONCLUSIONS

Although both methods were feasible for estimating body weight at different single-slice CT levels, the linear regression model using total cross-sectional body area at the T5 level as an input variable was the most favorable method for single-slice CT analysis for estimating body weight.

Improving the depiction of small intracranial vessels in head computed tomography angiography: a comparative analysis of deep learning reconstruction and hybrid iterative reconstruction

This study aimed to evaluate the ability of deep learning reconstruction (DLR) compared to that of hybrid iterative reconstruction (IR) to depict small vessels on computed tomography (CT). DLR and two types of hybrid IRs were used for image reconstruction. The target vessels were the basilar artery (BA), superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA). The peak value, ΔCT values defined as the difference between the peak value and background, and full width at half maximum (FWHM), were obtained from the profile curves. In all target vessels, the peak and ΔCT values of DLR were significantly higher than those of the two types of hybrid IR (p < 0.001). Compared to that associated with hybrid IR, the FWHM of DLR was significantly lower in the SCA (p < 0.001), AICA (p < 0.001), and PICA (p < 0.001). In conclusion, DLR has the potential to improve visualization of small vessels.

Globo-series Gb4 activates ERK and promotes the proliferation of osteoblasts

OBJECTIVES

Globo-series Gb4 (globoside) is involved in the immune system and disease pathogenesis. We recently reported that systemic Gb4 deficiency in mice led to decreased bone formation due to a reduction in osteoblast number. However, it remains unclear whether Gb4 expressed in osteoblasts promotes their proliferation. Therefore, we investigated the role of Gb4 in osteoblast proliferation in vitro.

METHODS

We examined osteoblast proliferation in Gb3 synthase knockout mice lacking Gb4. We investigated the effects of Gb4 synthase knockdown in the mouse osteoblast cell line MC3T3-E1 on its proliferation. Furthermore, we administered Gb4 to MC3T3-E1 cells in which Gb4 was suppressed by a glucosylceramide synthase (GCS) inhibitor and evaluated its effects on their proliferation. To elucidate the mechanisms by which Gb4 promotes osteoblast proliferation, the phosphorylated extracellular signal-regulated kinases 1 and 2 (ERK1/2) levels were measured in MC3T3-E1 cells.

RESULTS

Osteoblast proliferation was lower in Gb3 synthase knockout mice lacking Gb4 than in wild-type mice. Proliferation was inhibited by Gb4 synthase knockdown in MC3T3-E1 cells. Furthermore, the administration of Gb4 to MC3T3-E1 cells, in which a GCS inhibitor suppressed Gb4, promoted their proliferation. Moreover, it increased the phosphorylated ERK1/2 levels in MC3T3-E1 cells.

CONCLUSIONS

Our results suggest that Gb4 expressed in osteoblasts promotes their proliferation through ERK1/2 activation.

Electrically driven europium-doped GaN microdisk

For the practical implementation of microdisk resonators as active nanophotonic devices, it is essential that they can be electrically driven. However, it is difficult to inject current in such small-scale devices without severely degrading their optical properties. We demonstrate the successful fabrication of an electrically injected microdisk based on Eu-doped GaN, in which an SiO2 spacer is used to prevent the interaction of the metal contact with the optical resonances. The microdisk shows Eu-related emission upon electrical injection and from the observed resonance peak, a cavity quality (Q)-factor of 3400 is concluded.

First Observation of Electron Scattering from Online-Produced Radioactive Target

We successfully performed electron scattering off unstable nuclei which were produced online from the photofission of uranium. The target ^{137}Cs ions were trapped with a new target-forming technique that makes a high-density stationary target from a small number of ions by confining them in an electron storage ring. After developments of target generation and transportation systems and the beam stacking method to increase the ion beam intensity up to approximately 2×10^{7} ions per pulse beam, an average luminosity of 0.9×10^{26}  cm^{-2} s^{-1} was achieved for ^{137}Cs. The obtained angular distribution of elastically scattered electrons is consistent with a calculation. This success marks the realization of the anticipated femtoscope which clarifies the structures of exotic and short-lived unstable nuclei.

Estimation of Left and Right Ventricular Ejection Fractions from cine-MRI Using 3D-CNN

Cardiac function indices must be calculated using tracing from short-axis images in cine-MRI. A 3D-CNN (convolutional neural network) that adds time series information to images can estimate cardiac function indices without tracing using images with known values and cardiac cycles as the input. Since the short-axis image depicts the left and right ventricles, it is unclear which motion feature is captured. This study aims to estimate the indices by learning the short-axis images and the known left and right ventricular ejection fractions and to confirm the accuracy and whether each index is captured as a feature. A total of 100 patients with publicly available short-axis cine images were used. The dataset was divided into training:test = 8:2, and a regression model was built by training with the 3D-ResNet50. Accuracy was assessed using a five-fold cross-validation. The correlation coefficient, MAE (mean absolute error), and RMSE (root mean squared error) were determined as indices of accuracy evaluation. The mean correlation coefficient of the left ventricular ejection fraction was 0.80, MAE was 9.41, and RMSE was 12.26. The mean correlation coefficient of the right ventricular ejection fraction was 0.56, MAE was 11.35, and RMSE was 14.95. The correlation coefficient was considerably higher for the left ventricular ejection fraction. Regression modeling using the 3D-CNN indicated that the left ventricular ejection fraction was estimated more accurately, and left ventricular systolic function was captured as a feature.

Deep learning-based body weight from scout images can be an alternative to actual body weight in CT radiation dose management

PURPOSE

Accurate body weight measurement is essential to promote computed tomography (CT) dose optimization; however, body weight cannot always be measured prior to CT examination, especially in the emergency setting. The aim of this study was to investigate whether deep learning-based body weight from chest CT scout images can be an alternative to actual body weight in CT radiation dose management.

METHODS

Chest CT scout images and diagnostic images acquired for medical checkups were collected from 3601 patients. A deep learning model was developed to predict body weight from scout images. The correlation between actual and predicted body weight was analyzed. To validate the use of predicted body weight in radiation dose management, the volume CT dose index (CTDI_vol ) and the dose-length product (DLP) were compared between the body weight subgroups based on actual and predicted body weight. Surrogate size-specific dose estimates (SSDEs) acquired from actual and predicted body weight were compared to the reference standard.

RESULTS

The median actual and predicted body weight were 64.1 (interquartile range: 56.5-72.4) and 64.0 (56.3-72.2) kg, respectively. There was a strong correlation between actual and predicted body weight (ρ = 0.892, p < 0.001). The CTDI_vol and DLP of the body weight subgroups were similar based on actual and predicted body weight (p < 0.001). Both surrogate SSDEs based on actual and predicted body weight were not significantly different from the reference standard (p = 0.447 and 0.410, respectively).

CONCLUSION

Predicted body weight can be an alternative to actual body weight in managing dose metrics and simplifying SSDE calculation. Our proposed method can be useful for CT radiation dose management in adult patients with unknown body weight.

Acquisition time reduction in pediatric 99m Tc-DMSA planar imaging using deep learning

PURPOSE

Given the potential risk of motion artifacts, acquisition time reduction is desirable in pediatric ^99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy. The aim of this study was to evaluate the performance of predicted full-acquisition-time images from short-acquisition-time pediatric ^99m Tc-DMSA planar images with only 1/5th acquisition time using deep learning in terms of image quality and quantitative renal uptake measurement accuracy.

METHODS

One hundred and fifty-five cases that underwent pediatric ^99m Tc-DMSA planar imaging as dynamic data for 10 min were retrospectively collected for the development of three deep learning models (DnCNN, Win5RB, and ResUnet), and the generation of full-time images from short-time images. We used the normalized mean squared error (NMSE), peak signal-to-noise ratio (PSNR), and structural similarity index metrics (SSIM) to evaluate the accuracy of the predicted full-time images. In addition, the renal uptake of ^99m Tc-DMSA was calculated, and the difference in renal uptake from the reference full-time images was assessed using scatter plots with Pearson correlation and Bland-Altman plots.

RESULTS

The predicted full-time images from the deep learning models showed a significant improvement in image quality compared to the short-time images with respect to the reference full-time images. In particular, the predicted full-time images obtained by ResUnet showed the lowest NMSE (0.4 [0.4-0.5] %) and the highest PSNR (55.4 [54.7-56.1] dB) and SSIM (0.997 [0.995-0.997]). For renal uptake, an extremely high correlation was achieved in all short-time and three predicted full-time images (R²  > 0.999 for all). The Bland-Altman plots showed the lowest bias (-0.10) of renal uptake in ResUnet, while short-time images showed the lowest variance (95% confidence interval: -0.14, 0.45) of renal uptake.

CONCLUSIONS

Our proposed method is capable of producing images that are comparable to the original full-acquisition-time images, allowing for a reduction of acquisition time/injected dose in pediatric ^99m Tc-DMSA planar imaging.

Prediction of body weight from chest radiographs using deep learning with a convolutional neural network

Accurate body weights are not necessarily available in routine clinical practice. This study aimed to investigate whether body weight can be predicted from chest radiographs using deep learning. Deep-learning models with a convolutional neural network (CNN) were trained and tested using chest radiographs from 85,849 patients. The CNN models were evaluated by calculating the mean absolute error (MAE) and Spearman's rank correlation coefficient (ρ). The MAEs of the CNN models were 2.63 kg and 3.35 kg for female and male patients, respectively. The predicted body weight was significantly correlated with the actual body weight (ρ = 0.917, p < 0.001 for females; ρ = 0.915, p < 0.001 for males). The body weight was predicted using chest radiographs by applying deep learning. Our method is potentially useful for radiation dose management, determination of the contrast medium dose, and estimation of the specific absorption rate in patients with unknown body weights.

Toward automatic reformation at the orbitomeatal line in head computed tomography using object detection algorithm

Consistent cross-sectional imaging is desirable to accurately detect lesions and facilitate follow-up in head computed tomography (CT). However, manual reformation causes image variations among technologists and requires additional time. We therefore developed a system that reformats head CT images at the orbitomeatal (OM) line and evaluated the system performance using real-world clinical data. Retrospective data were obtained for 681 consecutive patients who underwent non-contrast head CT. The datasets were randomly divided into one of three sets for training, validation, or testing. Four landmarks (bilateral eyes and external auditory canal) were detected with the trained You Look Only Once (YOLO)v5 model, and the head CT images were reformatted at the OM line. The precision, recall, and mean average precision at the intersection over union threshold of 0.5 were computed in the validation sets. The reformation quality in testing sets was evaluated by three radiological technologists on a qualitative 4-point scale. The precision, recall, and mean average precision of the trained YOLOv5 model for all categories were 0.688, 0.949, and 0.827, respectively. In our environment, the mean implementation time was 23.5 ± 2.4 s for each case. The qualitative evaluation in the testing sets showed that post-processed images of automatic reformation had clinically useful quality with scores 3 and 4 in 86.8%, 91.2%, and 94.1% for observers 1, 2, and 3, respectively. Our system demonstrated acceptable quality in reformatting the head CT images at the OM line using an object detection algorithm and was highly time efficient.

Ultrasonic Evaluation of the Heel Fat Pad under Weight-Bearing Conditions Using a Polymethylpentene Resin Plate: Part 1

To evaluate the two-layer structure of the heel fat pad (HFP) from non-weight-bearing to full-weight-bearing conditions, we developed an instrument that assesses these changes from the sole through a polymethylpentene resin plate (PMP) with ultrasonography. For actual use, we investigated the influence on measured values and ultrasonogram appearance by interposing the PMP. Additionally, as the PMP may be bent under weight-bearing conditions, its influence on the measured values was investigated. First, two examiners measured the distances inside the phantom with and without a PMP. Second, ultrasonograms were obtained from 40 healthy adults with and without a PMP, and the thicknesses of the whole layer and the two layers of the HFP were measured using the same ultrasonogram. For each experiment, reproducibility was investigated. Third, the distances inside the phantom were measured and compared through the bent PMP, which models the weight-bearing condition, and the flat PMP. The reproducibility of the measurements was equivalent with and without the PMP interposed. Potential bias in measured values arising from deformation of PMP under weight-bearing conditions was not detected. Overall, the PMP's interposition and the bending of the PMP might not influence the measured values and reproducibility of the measurements.

Comparison of foot posture and foot muscle morphology between lifesaver athletes and healthy adults

This study aimed to compare the foot muscle morphology and foot posture between healthy adults and lifesavers in sandy beach sports. The participants included 15 lifesaver athletes and 15 healthy adults. Using a non-contact three-dimensional foot measurement device, the foot length, width, and arch height of the right foot were measured while standing and sitting without back support, and the transverse arch length ratio and arch height index were subsequently calculated. Muscle cross-sectional area was measured using an ultrasound imaging device. Muscle cross-sectional areas, arch height, foot width, arch height index, and transverse arch length ratio were larger in the lifesaver than in the healthy adult group. Lifesavers had higher arches and more developed intrinsic and extrinsic muscles than healthy adults. Performing physical activity while barefoot on sandy beaches may effectively develop the foot intrinsic and extrinsic muscles and raise the arch.

A deep-learning method using computed tomography scout images for estimating patient body weight

Body weight is an indispensable parameter for determination of contrast medium dose, appropriate drug dosing, or management of radiation dose. However, we cannot always determine the accurate patient body weight at the time of computed tomography (CT) scanning, especially in emergency care. Time-efficient methods to estimate body weight with high accuracy before diagnostic CT scans currently do not exist. In this study, on the basis of 1831 chest and 519 abdominal CT scout images with the corresponding body weights, we developed and evaluated deep-learning models capable of automatically predicting body weight from CT scout images. In the model performance assessment, there were strong correlations between the actual and predicted body weights in both chest (ρ = 0.947, p < 0.001) and abdominal datasets (ρ = 0.869, p < 0.001). The mean absolute errors were 2.75 kg and 4.77 kg for the chest and abdominal datasets, respectively. Our proposed method with deep learning is useful for estimating body weights from CT scout images with clinically acceptable accuracy and potentially could be useful for determining the contrast medium dose and CT dose management in adult patients with unknown body weight.

Promotion in solid phase reaction of Pt/SiOx bilayer film by electron-orbital-selective-excitation

A thermally impossible positive free energy reaction can proceed by electron-orbital-selective excitation. When the Si 2p core level is photo-excited in Pt/SiO_x bilayer films, Coulomb repulsion at the final two-hole state localized in the valence band by an interatomic Auger transition induces dissociation of the O atom and formation of a Si–Pt bond. Consequently, Pt₂Si silicide is formed by a positive free energy reaction. Under a single particle excitation of the valence band, low probability of the coexistence of the two-hole state for picosecond order suppresses to allow the reaction to proceed.

A thermally impossible positive free energy reaction can proceed by electron-orbital-selective excitation.

CT dose management of adult patients with unknown body weight using an effective diameter

PURPOSE

To assess the usefulness of effective diameter (D_eff) for CT dose management of adult patients with unknown body weight.

METHODS

A total of 642 adult patients whose height and weight had been measured before CT examination (chest CT using Aquilion Prime SP, 428 patients; chest CT using Biograph mCT, 100 patients; and abdominal CT using Aquilion Prime SP, 114 patients) were retrospectively examined between April 2018 and September 2019. The D_eff was automatically calculated from the lateral diameter on a CT localizer radiograph by a dose management software (Radimetrics). In order to determine the correlation between body weight and D_eff, we compared volume CT dose index and dose length product between patients with body weight between 50 and 70 kg and those with D_eff equivalent to body weight between 50 and 70 kg. Correlation analysis was performed by Pearson's product-moment correlation, and statistical analyses were performed by using t-test.

RESULTS

The correlation coefficient values between body weight and D_eff were 0.920 for chest CT using Aquilion Prime SP, 0.929 for chest CT using Biograph mCT, and 0.805 for abdominal CT using Aquilion Prime SP. In both chest and abdominal CT scans, there were no significant differences in volume CT dose index and dose length product between patients with body weight between 50 and 70 kg and those with D_eff equivalent to body weight between 50 and 70 kg.

CONCLUSIONS

The D_eff may be useful as a somatometric parameter for CT dose management of adult patients with unknown body weight.

Optimal slice thickness of brain computed tomography using a hybrid iterative reconstruction algorithm for identifying hyperdense middle cerebral artery sign of acute ischemic stroke

PURPOSE

To determine the optimal slice thickness of brain non-contrast computed tomography using a hybrid iterative reconstruction algorithm to identify hyperdense middle cerebral artery sign in patients with acute ischemic stroke.

METHODS

We retrospectively enrolled 30 patients who had presented hyperdense middle cerebral artery sign and 30 patients who showed no acute ischemic change in acute magnetic resonance imaging. Reformatted axial images at an angle of the orbitomeatal line in slice thicknesses of 0.5, 1, 3, 5, and 7 mm were generated. Optimal slice thickness for identifying hyperdense middle cerebral artery sign was evaluated by a receiver operating characteristics curve analysis and area under the curve (AUC).

RESULTS

The mean AUC value of 0.5-mm slice (0.921; 95% confidence interval (95% CI), 0.868 to 0.975) was significantly higher than those of 3-mm (0.791; 95% CI, 0.686 to 0.895; p = 0.041), 5-mm (0.691; 95% CI, 0.583 to 0.799, p < 0.001), and 7-mm (0.695; 95% CI, 0.593 to 0.797, p < 0.001) slices, whereas it was equivalent to that of 1-mm slice (0.901; 95% CI, 0.837 to 0.965, p = 0.751).

CONCLUSION

Thin slice thickness of ≤ 1 mm has a better diagnostic performance for identifying hyperdense artery sign on brain non-contrast computed tomography with a hybrid iterative reconstruction algorithm in patients with acute ischemic stroke.

Size dependence of quantum efficiency of red emission from GaN:Eu structures for application in micro-LEDs

GaN-based micro-LEDs typically suffer from a size-dependent efficiency due to the relatively long carrier lifetime and sidewall-related recombination effects. We demonstrate that for red-emitting Eu-doped GaN, sidewall-related recombination is hardly an issue for emission efficiency. We determine the photoluminescence quantum efficiency (PL QE) of Eu-related emission as a function of the size of square structures ranging from 3 to 192 µm. With the support of finite-difference time-domain simulations, we show that the light extraction efficiency and material losses are responsible for the decrease in PL QE for large sizes. For sizes smaller than 24 µm, there is an influence of the sidewall-related non-radiative recombination of carriers on the PL QE; however, it is only minor as a result of the limited carrier diffusion lengths in the Eu-doped material. These properties combined with the high efficiency of luminescence indicate the potential of this material for micro-LED applications.

Reduction of respiratory motion artifacts in gadoxetate-enhanced MR with a deep learning-based filter using convolutional neural network

Objectives

To reveal the utility of motion artifact reduction with convolutional neural network (MARC) in gadoxetate disodium–enhanced multi-arterial phase MRI of the liver.

Methods

This retrospective study included 192 patients (131 men, 68.7 ± 10.3 years) receiving gadoxetate disodium–enhanced liver MRI in 2017. Datasets were submitted to a newly developed filter (MARC), consisting of 7 convolutional layers, and trained on 14,190 cropped images generated from abdominal MR images. Motion artifact for training was simulated by adding periodic k-space domain noise to the images. Original and filtered images of pre-contrast and 6 arterial phases (7 image sets per patient resulting in 1344 sets in total) were evaluated regarding motion artifacts on a 4-point scale. Lesion conspicuity in original and filtered images was ranked by side-by-side comparison.

Results

Of the 1344 original image sets, motion artifact score was 2 in 597, 3 in 165, and 4 in 54 sets. MARC significantly improved image quality over all phases showing an average motion artifact score of 1.97 ± 0.72 compared to 2.53 ± 0.71 in original MR images (p < 0.001). MARC improved motion scores from 2 to 1 in 177/596 (29.65%), from 3 to 2 in 119/165 (72.12%), and from 4 to 3 in 34/54 sets (62.96%). Lesion conspicuity was significantly improved (p < 0.001) without removing anatomical details.

Conclusions

Motion artifacts and lesion conspicuity of gadoxetate disodium–enhanced arterial phase liver MRI were significantly improved by the MARC filter, especially in cases with substantial artifacts. This method can be of high clinical value in subjects with failing breath-hold in the scan.

Key Points

• This study presents a newly developed deep learning–based filter for artifact reduction using convolutional neural network (motion artifact reduction with convolutional neural network, MARC).

• MARC significantly improved MR image quality after gadoxetate disodium administration by reducing motion artifacts, especially in cases with severely degraded images.

• Postprocessing with MARC led to better lesion conspicuity without removing anatomical details.

[Scatter Radiation Intensities during Transforaminal Lumbar Interbody Fusion Using a Mobile C-arm System]

The purpose of this study was to measure the scatter radiation intensity during transforaminal lumbar interbody fusion using a mobile C-arm system (Arcadis Orbic 3D; Siemens) and minimize radiation exposure. Dosimetry was performed with anterior-posterior and lateral continuous fluoroscopy, and cone beam computed tomography (CT). A scaffold tower (L: 300 cm×W: 200 cm×H: 150 cm) was built with radiation-resistant paper cylinders at intervals of 50 cm and plastic joints over the bed, and 100 optically stimulated luminescence dosimeters (nanoDot; Nagase Landauer) were placed on each joint. A human torso phantom from head to pelvis (Kyoto Kagaku) was positioned on the bed in a prone position. The scatter radiation dose in a lateral view was highest on the X-ray tube side at the height of 100 cm (170.5 μGy/min). The scatter radiation dose increased significantly on the X-ray tube side during lateral continuous fluoroscopy. Continuous change of surgeons' standing positions is important to minimize radiation exposure received by a specific surgeon.

A survey of the implementation status of selected infection control strategies in neonatal intensive care units in Japan

BACKGROUND

Infection control strategies are implemented in all neonatal intensive care units (NICUs); however, the details of the strategies seem to differ among institutions. The purpose of this survey was to investigate the current implementation status of infection control strategies in NICUs in Japan and to identify and recommend appropriate strategies for the prevention of outbreaks in neonatal units.

METHODS

This survey documented the current implementation status and methods of selected infection prevention and control measures (active surveillance cultures and standard precaution) in 453 Japanese NICUs/neonatal units registered with the Japan Society of Perinatal and Neonatal Medicine, using questionnaires, in May 2018.

FINDINGS

The response rate was 48.1% (level I institutions, 25.5%; level II, 55.9%; level III, 64.2%). Surveillance cultures were performed every week and targeted all bacteria in most units. The proportion of level III institutions that experienced outbreaks over the previous five years was significantly higher than that of level II institutions (55% vs 27%, P=0.0003). However, wearing a mask was less frequently recommended in level III institutions (55.7%) than in level II institutions (67.9%). Meticillin-resistant Staphylococcus aureus (MRSA) was the most frequently reported bacterial pathogen responsible for NICU outbreaks.

CONCLUSION

Infection prevention and control practices regarding active pathogen surveillance cultures and the use of barrier precautions varied widely in Japanese neonatal units. National guidelines and evidence-based recommendations are needed to rationalize and standardize current infection prevention and control practices in neonatal units in Japan.

P1956Geriatric nutritional risk index as predictor for long-term survival and cardiovascular or limb events in peripheral arterial disease patients

Background

The geriatric nutritional risk index (GNRI) is a simple tool to assess the nutritional risk and associated with mortality. However, there are no reports focusing GNRI in peripheral artery disease (PAD) patients.

Purpose

The purpose of this study was to examine the effects of GNRI for long-term survival, cardiovascular and limb events in PAD patients.

Methods

A prospective cohort study was performed in 1219 PAD patients. Baseline GNRI was calculated from serum albumin level and body-mass-index. The patients were divided into four groups by GNRI level (G1: >98; G2: 92–98; G3: 82–91; G4: <82). The endpoints were overall survival (OS) and freedom from major adverse cardiovascular and limb events (MACE and MACLE).

Results

The median follow-up was 73 months. There were 626 deaths (51.4%) during follow-up. The rate of cardiovascular death among dead was 51.3%. The OS rates markedly depended on GNRI level (p<0.01). The 5-year OS rates were G1: 80.8%, G2: 62.0%, G3: 40.0%, G4: 23.3%, respectively. In multivariate analyses, GNRI, age, low ankle brachial pressure index (ABI), low estimated glomerular filtration rate (eGFR), and high C-reactive protein (CRP) levels were independent factors associated with OS (<0.05). GNRI, age, low ABI, diabetes mellitus, coronary artery disease, lower eGFR and higher CRP levels were associated with MACE and MACLE (p<0.05, respectively). Besides, statins improved OS, MACE, and MACLE (<0.01, respectively).

Conclusions

GNRI was an independent predictor for OS, MACE, and MACLE in PAD patients. Furthermore,statins improved OS, MACE and MACLE in patients with PAD.

Hepatobiliary phase hypointense nodule without arterial phase hyperenhancement as a risk factor for late recurrence (>1 year) of hepatocellular carcinoma after surgery

AIM

To evaluate the value of magnetic resonance imaging (MRI) features, including liver stiffness measured by magnetic resonance elastography (MRE) and the presence of hepatobiliary phase (HBP) hypointense nodule without arterial phase hyperenhancement (APHE), for predicting late recurrence (>1 year) after surgery for hepatocellular carcinoma (HCC).

MATERIALS AND METHODS

This retrospective study included 124 consecutive patients who had undergone surgery for HCC and preoperative MRI. After excluding patients with early recurrence within 1 year after surgery, 89 patients were analysed. Preoperative MRI images were reviewed by a radiologist to record imaging findings, including (1) liver stiffness by MRE, (2) size of the HCCs, (3) number of HCCs, and (4) presence of HBP hypointense nodule without APHE. Pathological findings included tumour grade, vascular/biliary/capsule invasion, and fibrosis stage of the liver. Considering imaging/pathological findings and patients' characteristics as dependent variables, Cox proportional hazards model analysis was performed to identify independent factors associated with late recurrence after surgery.

RESULTS

The median follow-up period was 37.3 months. During follow-up, 29 patients (32.5%) developed late recurrence after surgery. In multivariate analysis, underlying liver disease (viral hepatitis) and presence of HBP hypointense nodules without APHE (p=0.010 and 0.033, respectively) were independently associated with disease-free survival (DFS). Kaplan-Meier analysis revealed that patients with HBP hypointense nodules without APHE had a significantly lower DFS rate than those without the nodule (39.2% versus 74.1% at 3 years after surgery, p=0.008).

CONCLUSION

The presence of HBP hypointense nodules without APHE was an indicator of late recurrence after surgery for HCC.

Detection of Fine Radiographic Progression in Finger Joint Space Narrowing Beyond Human Eyes: Phantom Experiment and Clinical Study with Rheumatoid Arthritis Patients

The visual assessment of joint space narrowing (JSN) on radiographs of rheumatoid arthritis (RA) patients such as the Genant-modified Sharp score (GSS) is widely accepted but limited by its subjectivity and insufficient sensitivity. We developed a software application which can assess JSN quantitatively using a temporal subtraction technique for radiographs, in which the chronological change in JSN between two radiographs was defined as the joint space difference index (JSDI). The aim of this study is to prove the superiority of the software in terms of detecting fine radiographic progression in finger JSN over human observers. A micrometer measurement apparatus that can adjust arbitrary joint space width (JSW) in a phantom joint was developed to define true JSW. We compared the smallest detectable changes in JSW between the JSDI and visual assessment using phantom images. In a clinical study, 222 finger joints without interval score change on GSS in 15 RA patients were examined. We compared the JSDI between joints with and without synovial vascularity (SV) on power Doppler ultrasonography during the follow-up period. True JSW difference was correlated with JSDI for JSW differences ranging from 0.10 to 1.00 mm at increments of 0.10 mm (R² = 0.986 and P < 0.001). Rheumatologists were difficult to detect JSW difference of 0.30 mm or less. The JSDI of finger joints with SV was significantly higher than those without SV (P = 0.030). The software can detect fine differences in JSW that are visually unrecognizable.

Hyperphosphatemic familial tumoral calcinosis secondary to fibroblast growth factor 23 (FGF23) mutation: a report of two affected families and review of the literature

Hyperphosphatemic familial tumoral calcinosis (HFTC), secondary to fibroblast growth factor 23 (FGF23) gene mutation, is a rare genetic disorder characterized by recurrent calcified masses. We describe young Lebanese cousins presenting with HFTC, based on a retrospective chart review and a prospective case study. In addition, we present a comprehensive review on the topic, based on a literature search conducted in PubMed and Google Scholar, in 2014 and updated in December 2017. While the patients had the same previously reported FGF23 gene mutation (homozygous c.G367T variant in exon 3 leading to a missense mutation), they presented with variable severity and age of disease onset (at 4 years in patient 1 and at 23 years in patient 2). A review of the literature revealed several potential patho-physiologic pathways of HFTC clinical manifestations, some of which may be independent of hyperphosphatemia. Most available treatment options aim at reducing serum phosphate level, by stimulating renal excretion or by inhibiting intestinal absorption. HFTC is a challenging disease. While the available medical treatment has a limited and inconsistent effect on disease symptomatology, surgical resection of calcified masses remains the last resort. Research is needed to determine the safety and efficacy of FGF23 replacement or molecular therapy, targeting the specific genetic aberration. Hyperphosphatemic familial tumoral calcinosis is a rare genetic disorder characterized by recurrent calcified masses, in addition to other visceral, skeletal, and vascular manifestations. It remains a very challenging disease.

Radiographic temporal subtraction analysis can detect finger joint space narrowing progression in rheumatoid arthritis with clinical low disease activity

Background Recent papers suggest that finger joints with positive synovial vascularity (SV) assessed by ultrasonography under clinical low disease activity (CLDA) in rheumatoid arthritis (RA) patients may cause joint space narrowing (JSN) progression. Purpose To investigate the performance of a computer-based method by directly comparing with the conventional scoring method in terms of the detectability of JSN progression in hand radiography of RA patients with CLDA. Material and Methods Fifteen RA patients (13 women, 2 men) with long-term sustained CLDA of >2 years were included. Radiological progression of finger joints was measured or scored using the computer-based method which can detect JSN progression between two radiographic images as the joint space difference index (JSDI), as well as the Genant-modified Sharp score (GSS). We also quantitatively assessed SV of these joints using ultrasonography. Results Out of 270 joints, we targeted 259 finger joints after excluding nine damaged joints (four ankylosis, three complete luxation, and two subluxation) and two improved joints according to the GSS results. The JSDI of finger joints with JSN progression was significantly higher than those without JSN progression ( P = 0.018). The JSDI of finger joints with ultrasonographic SV was significantly higher than those without ultrasonographic SV ( P = 0.004). Progression in JSDI showed stronger associations with ultrasonographic SV than progression in GSS (odds ratio [95% confidence interval]: 7.19 [3.37-15.36] versus 5.84 [2.76-12.33]). Conclusion The computer-based method was comparable to the conventional scoring method regarding the detectability of JSN progression in RA patients with CLDA.

Quantification of hand synovitis in rheumatoid arthritis: Arterial mask subtraction reinforced with mutual information can improve accuracy of pixel-by-pixel time-intensity curve shape analysis in dynamic MRI

BACKGROUND

Synovitis, which is a hallmark of rheumatoid arthritis (RA), needs to be precisely quantified to determine the treatment plan. Time-intensity curve (TIC) shape analysis is an objective assessment method for characterizing the pixels as artery, inflamed synovium, or other tissues using dynamic contrast-enhanced MRI (DCE-MRI).

PURPOSE/HYPOTHESIS

To assess the feasibility of our original arterial mask subtraction method (AMSM) with mutual information (MI) for quantification of synovitis in RA.

STUDY TYPE

Prospective study.

SUBJECTS

Ten RA patients (nine women and one man; mean age, 56.8 years; range, 38-67 years).

FIELD STRENGTH/SEQUENCE

3T/DCE-MRI.

ASSESSMENT

After optimization of TIC shape analysis to the hand region, a combination of TIC shape analysis and AMSM was applied to synovial quantification. The MI between pre- and postcontrast images was utilized to determine the arterial mask phase objectively, which was compared with human subjective selection. The volume of objectively measured synovitis by software was compared with that of manual outlining by an experienced radiologist. Simple TIC shape analysis and TIC shape analysis combined with AMSM were compared in slices without synovitis according to subjective evaluation.

STATISTICAL TESTS

Pearson's correlation coefficient, paired t-test and intraclass correlation coefficient (ICC).

RESULTS

TIC shape analysis was successfully optimized in the hand region with a correlation coefficient of 0.725 (P < 0.01) with the results of manual assessment regarded as ground truth. Objective selection utilizing MI had substantial agreement (ICC = 0.734) with subjective selection. Correlation of synovial volumetry in combination with TIC shape analysis and AMSM with manual assessment was excellent (r = 0.922, P < 0.01). In addition, negative predictive ability in slices without synovitis pixels was significantly increased (P < 0.01).

DATA CONCLUSIONS

The combination of TIC shape analysis and image subtraction reinforced with MI can accurately quantify synovitis of RA in the hand by eliminating arterial pixels.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

Size-dependent uptake of electrically neutral amphipathic polymeric nanoparticles by cell-sized liposomes and an insight into their internalization mechanism in living cells

The size-dependent uptake of amphipathic uncharged-nanoparticles in cell-sized liposomes is emerging as a new insight into their internalization mechanism in living cells.

Impact of the structures of macrocyclic Michael acceptors on covalent proteasome inhibition

A systematic analysis of the structure–activity relationship of a series of syringolin analogues, which are irreversible covalent inhibitors of proteasomes.

Molecules that have a reactive functional group within a macrocycle represent a class of covalent inhibitor. The relationship between reactivity and affinity for the target is cooperative and complicated. An understanding and characterization of this class of inhibitor are vital for the development of covalent inhibitors as drug candidates. Herein, we describe a systematic analysis of structure–activity relationships using a series of syringolin analogues, which are irreversible covalent inhibitors of proteasomes. We investigate the detailed mechanistic effects of the macrocycles on affinity and reaction rate.

Cartilage quantification using contrast-enhanced MRI in the wrist of rheumatoid arthritis: cartilage loss is associated with bone marrow edema

OBJECTIVE

To quantify wrist cartilage using contrast MRI and compare with the extent of adjacent synovitis and bone marrow edema (BME) in patients with rheumatoid arthritis (RA).

METHODS

18 patients with RA underwent post-contrast fat-suppressed T₁weighted coronal imaging. Cartilage area at the centre of the scaphoid-capitate and radius-scaphoid joints was measured by in-house developed software. We defined cartilage as the pixels with signal intensity between two thresholds (lower: 0.4, 0.5 and 0.6 times the muscle signal, upper: 0.9, 1.0, 1.1, 1.2 and 1.3 times the muscle signal). We investigated the association of cartilage loss with synovitis and BME score derived from RA MRI scoring system.

RESULTS

Cartilage area was correlated with BME score when thresholds were adequately set with lower threshold at 0.6 times the muscle signal and upper threshold at 1.2 times the muscle signal for both SC (r_s=-0.469, p < 0.05) and RS (r_s=-0.486, p < 0.05) joints, while it showed no significant correlation with synovitis score at any thresholds.

CONCLUSION

Our software can accurately quantify cartilage in the wrist and BME associated with cartilage loss in patients with RA. Advances in knowledge: Our software can quantify cartilage using conventional MR images of the wrist. BME is associated with cartilage loss in RA patients.

First Elastic Electron Scattering from ^{132}Xe at the SCRIT Facility

The first elastic electron scattering has been successfully performed at the self-confining radioactive-isotope ion target (SCRIT) facility, the world's first electron scattering facility for SCRIT technique achieved high luminosity (over 10^{27}  cm^{-2} s^{-1}, sufficient for determining the nuclear shape) with only 10^{8} target ions. While ^{132}Xe used in this time as a target is a stable isotope, the charge density distribution was first extracted from the momentum transfer distributions of the scattered electrons by comparing the results with those calculated by a phase shift calculation.

MKRN2 is a novel ubiquitin E3 ligase for the p65 subunit of NF-κB and negatively regulates inflammatory responses

Activation of NF-κB transcription factor is strictly regulated to prevent excessive inflammatory responses leading to immunopathology. However, it still remains unclear how NF-κB activation is negatively controlled. The PDZ-LIM domain-containing protein PDLIM2 is a nuclear ubiquitin E3 ligase targeting the p65 subunit of NF-κB for degradation, thus terminating NF-κB-mediated inflammation. Using yeast two-hybrid screening, we sought to isolate PDLIM2-interacting proteins that are critical for suppressing NF-κB signaling. Here we identified MKRN2, a RING finger domain-containing protein that belongs to the makorin ring finger protein gene family, as a novel p65 ubiquitin E3 ligase. MKRN2 bound to p65 and promoted the polyubiquitination and proteasome-dependent degradation of p65 through the MKRN2 RING finger domain, thereby suppressing p65-mediated NF-κB transactivation. Notably, MKRN2 and PDLIM2 synergistically promote polyubiquitination and degradation of p65. Consistently, MKRN2 knockdown in dendritic cells resulted in larger amounts of nuclear p65 and augmented production of proinflammatory cytokines in responses to innate stimuli. These results delineate a novel role of MKRN2 in negatively regulating NF-κB-mediated inflammatory responses, cooperatively with PDLIM2.

Semi-Automated Quantification of Finger Joint Space Narrowing Using Tomosynthesis in Patients with Rheumatoid Arthritis

The purpose of the study is to validate the semi-automated method using tomosynthesis images for the assessment of finger joint space narrowing (JSN) in patients with rheumatoid arthritis (RA), by using the semi-quantitative scoring method as the reference standard. Twenty patients (14 females and 6 males) with RA were included in this retrospective study. All patients underwent radiography and tomosynthesis of the bilateral hand and wrist. Two rheumatologists and a radiologist independently scored JSN with two modalities according to the Sharp/van der Heijde score. Two observers independently measured joint space width on tomosynthesis images using an in-house semi-automated method. More joints with JSN were revealed with tomosynthesis score (243 joints) and the semi-automated method (215 joints) than with radiography (120 joints), and the associations between tomosynthesis scores and radiography scores were demonstrated (P < 0.001). There was significant, negative correlation between measured joint space width and tomosynthesis scores with r = -0.606 (P < 0.001) in metacarpophalangeal joints and r = -0.518 (P < 0.001) in proximal interphalangeal joints. Inter-observer and intra-observer agreement of the semi-automated method using tomosynthesis images was in almost perfect agreement with intra-class correlation coefficient (ICC) values of 0.964 and 0.963, respectively. The semi-automated method using tomosynthesis images provided sensitive, quantitative, and reproducible measurement of finger joint space in patients with RA.

Antibacterial Nucleoside Natural Products Inhibiting Phospho-MurNAc-Pentapeptide Translocase; Chemistry and Structure-Activity Relationship

The continued emergence of drug-resistance to existing antibacterial agents represents a severe and ongoing public health concern, which demands the discovery of new antibiotics. However the number of novel classes of antibacterial drugs launched in the clinic has been remarkably slow since the 1960s, and it is urgent to develop novel antibacterial agents to fight against drug-resistant bacterial pathogens. Peptidoglycan is a component of the bacterial cell wall, which consists of a repeated N-acetylmuramic acid (MurNAc) and Nacetylglucosamine (GluNAc) polymer cross-linked with polypeptides, and is a good target for antibacterial drug discovery. Among enzymes responsible for its biosynthesis, phospho-MurNAc-pentapeptide translocase (MraY) is a novel and promising target. Many nucleoside natural products, which strongly inhibit MraY, have been found in nature. This review will summarize the synthesis and biological properties of selected MraY inhibitory nucleoside natural products and their analogues synthesized in our laboratory and by others.

Effect of Antihypertensive Therapy on Blood Rheology in Patients with Essential Hypertension

Hypertension is an important risk factor for cardiovascular disease, and antihypertensive drugs can decrease the occurrence of such events in hypertensive patients. This study compared the rheological properties of blood in 22 untreated hypertensive patients, 42 patients taking antihypertensive drugs and 74 normotensive subjects. Using a microchannel method, the whole blood passage time was measured and blood movement was observed with a microscope connected to an image display unit. The blood passage time in untreated hypertensive patients was significantly higher than in treated hypertensive patients or normotensive subjects, but was similar in the latter two groups. Microscopic observations showed that platelet aggregation and leucocyte adhesion were increased in untreated hypertensive patients, resulting in poor flow, while blood samples from treated hypertensive patients and normotensive subjects passed smoothly through the microchannels. These rheological differences could contribute to the decrease in cardiovascular disease seen when hypertensive patients are treated effectively.

Radiographic quantifications of joint space narrowing progression by computer-based approach using temporal subtraction in rheumatoid wrist

OBJECTIVE

To investigate the validity of a computer-based method using temporal subtraction in carpal joints of patients with rheumatoid arthritis (RA), which can detect the difference in joint space between two images with the joint space difference index (JSDI).

METHODS

The study consisted of 43 patients with RA (39 females and 4 males) who underwent radiography at baseline and at 1-year follow-up. The joint space narrowing (JSN) of carpal joints on bilateral hand radiographs was assessed by our computer-based method, using the Sharp/van der Heijde method as the standard of reference. We compared the JSDI of joints with JSN progression in the follow-up period with that of those without JSN progression. In addition, we examined whether there is a significant difference in JSDI in terms of laterality or topology of the joint.

RESULTS

The JSDI of joints with JSN progression was significantly higher than that of those without JSN progression (Mann-Whitney U test, p < 0.001). There was no statistically significant difference in the JSDI between the left and right carpal joints, which was analysed for five different joints altogether and each joint separately (Mann-Whitney U test, p > 0.05). There was statistically significant difference in JSDI among different joints (Kruskal-Wallis test, p = 0.003).

CONCLUSION

These results suggest that our computer-based method may be useful to recognize the JSN progression on radiographs of rheumatoid wrists.

ADVANCES IN KNOWLEDGE

The computer-based temporal subtraction method can detect the JSN progression in the wrist, which is the single most commonly involved site in RA.

Performance of computer-based analysis using temporal subtraction to assess joint space narrowing progression in rheumatoid patients

Our computer-based method can detect the chronological change in joint space width between baseline and follow-up images as the joint space difference index (JSDI). The aim of this study was to verify the sensitivity and specificity of our computer-based method in assessment of joint space narrowing progression in rheumatoid patients. Twenty-seven patients (24 women and 3 men) with rheumatoid arthritis underwent radiography of the bilateral hand at baseline and at 1 year. The joint space narrowing (JSN) of a total of 252 metacarpophalangeal (MCP) joints and 229 carpal joints was assessed by our computer-based method, setting the Sharp/van der Heijde method as the gold standard. We constructed a receiver operating characteristic curve by using the Sharp/van der Heijde method as the gold standard and set the optimal cutoff on JSDI for MCP, carpal, and MCP/carpal joints. We then calculated the sensitivity and specificity for each cutoff in assessment of JSN progression. At the most discriminant cutoff, the sensitivity and specificity of the computer-based method for MCP joints was 78.6 versus 85.3 %, respectively (AUC = 0.837; P < 0.001). Carpal joints revealed a lower sensitivity and specificity with 64.7 and 86.8 % (AUC = 0.775; P < 0.001). Furthermore, the sensitivity and specificity for MCP/carpal joints was 71.0 versus 83.6 %, respectively (AUC = 0.778; P < 0.001). The computer-based method presented a reliable assessment of JSN progression with high sensitivity and specificity and may be useful in follow-up assessment of the joint damage in rheumatoid patients.

Evaluation of floating impeller phenomena in a Gyro centrifugal pump

The Gyro centrifugal pump developed as a totally implantable artificial heart was designed with a free impeller, in which the rotational shaft (male bearing) of the impeller was completely separated from the female bearing. For this type of pump, it is very important to keep the proper magnet balance (impeller-magnet and actuator-magnet) in order to prevent thrombus formation and/or bearing wear. When the magnet balance is not proper, the impeller is jerked down into the bottom bearing. On the other hand, if magnet balance is proper, the impeller lifted off the bottom of the pump housing within a certain range of pumping conditions. In this study, this floating phenomenon was investigated in detail. The floating phenomenon was proved by observation of the impeller behavior using a transparent acrylic pump. The impeller floating phenomenon was mapped on a pump performance curve. The impeller floating phenomenon is affected by the magnet-magnet coupling distance and rotational speed of the impeller. In order to keep the proper magnet balance and to maintain the impeller floating phenomenon at the driving condition of right and left pump, the magnet-magnet coupling distance was altered by a spacer which was installed between the pump and actuator. It became clear that the same pump could handle different conditions (right and left ventricular assist), by just changing the thickness of the spacer. When magnet balance is proper, the floating impeller phenomenon occurs automatically in response to the impeller rev. It is called "the dynamic RPM suspension".

Wall-loss distribution of charge breeding ions in an electron cyclotron resonance ion source

We investigated the ion-loss distribution on the sidewall of an electron cyclotron resonance (ECR) plasma chamber using the 18-GHz ECR charge breeder at the Tokai Radioactive Ion Accelerator Complex (TRIAC). Similarities and differences between the ion-loss distributions (longitudinal and azimuthal) of different ion species (i.e., radioactive (111)In(1+) and (140)Xe(1+) ions that are typical volatile and nonvolatile elements) was qualitatively discussed to understand the element dependence of the charge breeding efficiency. Especially, the similarities represent universal ion loss characteristics in an ECR charge breeder, which are different from the loss patterns of electrons on the ECRIS wall.