Study on the detection method of biological characteristics of hepatoma cells based on terahertz time-domain spectroscopy

Liver cancer usually has a high degree of malignancy and its early symptoms are hidden, therefore, it is of significant research value to develop early-stage detection methods of liver cancer for pathological screening. In this paper, a biometric detection method for living human hepatocytes based on terahertz time-domain spectroscopy was proposed. The difference in terahertz response between normal and cancer cells was analyzed, including five characteristic parameters in the response, namely refractive index, absorption coefficient, dielectric constant, dielectric loss and dielectric loss tangent. Based on class separability and variable correlation, absorption coefficient and dielectric loss were selected to better characterize cellular properties. Maximum information coefficient and principal component analysis were employed for feature extraction, and a cell classification model of support vector machine was constructed. The results showed that the algorithm based on parameter feature fusion can achieve an accuracy of 91.6% for human hepatoma cell lines and one normal cell line. This work provides a promising solution for the qualitative evaluation of living cells in liquid environment.

Microfluidic Channel-Based Soft Electrodes and Their Application in Capacitive Pressure Sensing

Flexible and stretchable electrodes are essential components in soft artificial sensory systems. Despite recent advances in flexible electronics, most electrodes are either restricted by the patterning resolution or the capability of inkjet printing with high-viscosity super-elastic materials. In this paper, we present a simple strategy to fabricate microchannel-based stretchable composite electrodes, which can be achieved by scraping elastic conductive polymer composites (ECPCs) into lithographically embossed microfluidic channels. The ECPCs were prepared by a volatile solvent evaporation method, which achieves a uniform dispersion of carbon nanotubes (CNTs) in a polydimethylsiloxane (PDMS) matrix. Compared to conventional fabrication methods, the proposed technique can facilitate the rapid fabrication of well-defined stretchable electrodes with high-viscosity slurry. Since the electrodes in this work were made up of all-elastomeric materials, strong interlinks can be formed between the ECPCs-based electrodes and the PDMS-based substrate at the interfaces of the microchannel walls, which allows the electrodes to exhibit mechanical robustness under high tensile strains. In addition, the mechanical-electric response of the electrodes was also systematically studied. Finally, a soft pressure sensor was developed by combining a dielectric silicone foam and an interdigitated electrodes (IDE) layer, and this demonstrated great potential for pressure sensors in soft robotic tactile sensing applications.

Characterization and discrimination of human colorectal cancer cells using terahertz spectroscopy

Terahertz technology has been widely used in biomedical research. Herein, terahertz time-domain attenuated total reflection (THz TD-ATR) spectroscopy was employed to characterize and discriminate human cancer cell lines (DLD-1 and HT-29). Terahertz responses of the cell lines were measured and Savitzky-Golay algorithm was applied to smooth the spectra of refractive index, absorption coefficient and dielectric loss tangent in terahertz regime. Principal component analysis (PCA) was then adopted for feature extraction and cell characterization. Based on the processed data, cancer cell lines were discriminated by applying random forests (RF) method to analyze three characteristic parameters separately and the results from them were compared. Results indicate that absorption coefficient was the most sensitive parameter for cancer cell discrimination. Our study suggests great potential for human cancer cell recognition and provides experimental basis for liquid biopsy.

High-risk Stage III colon cancer patients identified by a novel five-gene mutational signature are characterized by upregulation of IL-23A and gut bacterial translocation of the tumor microenvironment

The heterogeneities of colorectal cancer (CRC) lead to staging inadequately of patients' prognosis. Here, we performed a prognostic analysis based on the tumor mutational profile and explored the characteristics of the high-risk tumors. We sequenced 338 colorectal carcinomas as the training dataset, constructed a novel five-gene (SMAD4, MUC16, COL6A3, FLG and LRP1B) prognostic signature, and validated it in an independent dataset from The Cancer Genome Atlas (TCGA). Kaplan-Meier and Cox regression analyses confirmed that the five-gene signature is an independent predictor of recurrence and prognosis in patients with Stage III colon cancer. The mutant signature translated to an increased risk of death (hazard ratio = 2.45, 95% confidence interval = 1.15-5.22, p = 0.016 in our dataset; hazard ratio = 4.78, 95% confidence interval = 1.33-17.16, p = 0.008 in TCGA dataset). RNA and bacterial 16S rRNA sequencing of high-risk tumors indicated that mutations of the five-gene signature may lead to intestinal barrier integrity, translocation of gut bacteria and deregulation of immune response and extracellular related genes. The high-risk tumors overexpressed IL23A and IL1RN genes and enriched with cancer-related bacteria (Bacteroides fragilis,Peptostreptococcus, Parvimonas, Alloprevotella and Gemella) compared to the low-risk tumors. The signature identified the high-risk group characterized by gut bacterial translocation and upregulation of interleukins of the tumor microenvironment, which was worth further researching.

Study on glycoprotein terahertz time-domain spectroscopy based on composite multiscale entropy feature extraction method

Tumor genesis is accompanied by glycosylation of related proteins. Glycoprotein is usually regarded as a tumor marker since glycoproteins are consumed remarkably more by the cancer cells than the normal ones. In this paper, the terahertz time-domain attenuated total reflection (ATR) technique is applied to inspect the glycoprotein solution from a concentration gradient of 0.2 mg/ml to 50 mg/ml. A significant nonlinear relationship between the absorption coefficient and the concentrations has been discovered. The influence of the dynamical hydration shell around glycoprotein molecules on the absorption coefficient is discussed and the phenomenon is explained by the concepts of THz excess and THz defect. In order to identify glycoproteins, features are obtained by composite multiscale entropy (CMSE) method and clustered by the K-means algorithm. The results indicate that features extracted by the CMSE method are better than the Principal Component Analysis (PCA) method in both specificity and sensitivity of recognition. Meanwhile, the absorption coefficient and dielectric loss angle tangent are more suitable for qualitative identification. Research shows that the CMSE method has important directive significance for analyzing glycoprotein terahertz spectroscopy. And it has the potential for glycoprotein related tumor markers identification using terahertz technology in medical applications.

Qualitative and quantitative detection of liver injury with terahertz time-domain spectroscopy

Terahertz technology has been widely used as a nondestructive and effective detection method. Herein, terahertz time-domain spectroscopy was used to detect drug-induced liver injury in mice. Firstly, the boxplots were used to detect abnormal data. Then the maximal information coefficient method was used to search for the features strongly correlated with the degree of injury. After that, the liver injury model was built using the random forests method in machine learning. The results show that this method can effectively identify the degree of liver injury and thus provide an auxiliary diagnostic method for detecting minor liver injury.

Analysis and inspection techniques for mouse liver injury based on terahertz spectroscopy

At present, researchers are exploring biological tissue detection method using terahertz techniques. In this paper, techniques to inspect mouse liver injury by using terahertz spectroscopy were studied. The boxplots were applied to remove abnormal data, and the maximal information coefficient was employed to select crucial features from the absorption coefficient and refractive index spectra. Random Forests and AdaBoost were applied to recognize different levels of liver injury. We found that AdaBoost had better performance on low-level injury classification. This work suggests that terahertz techniques have the potential to detect liver injury at an early stage and evaluate liver treatment strategies.

Inspecting human colon adenocarcinoma cell lines by using terahertz time-domain reflection spectroscopy

Techniques to inspect and analyze human colorectal cancer cell lines by using terahertz time-domain attenuated total reflection spectroscopy (THz TD-ATR) were investigated. The characteristics of THz absorption spectra of two colorectal cancer cell lines DLD-1 and HT-29 in aqueous solutions with different concentrations were studied. Different spectral features were observed compared to normal cell line. Identification results based on different parameters including absorption coefficient, refractive index, real and imaginary parts of complex permittivity, dielectric loss tangent were discussed. This research may be promising for quick and instant inspection of liquid samples by using THz time-domain spectroscopy in medical applications.

In situ detection of water quality contamination events based on signal complexity analysis using online ultraviolet-visible spectral sensor

The contaminant detection in water distribution systems is essential to protect public health from potentially harmful compounds resulting from accidental spills or intentional releases. As a noninvasive optical technique, ultraviolet-visible (UV-Vis) spectroscopy is investigated for detecting contamination events. However, current methods for event detection exhibit the shortcomings of noise susceptibility. In this paper, a new method that has less sensitivity to noise was proposed to detect water quality contamination events by analyzing the complexity of the UV-Vis spectrum series. The proposed method applied approximate entropy (ApEn) to measure spectrum signals' complexity, which made a distinction between normal and abnormal signals. The impact of noise was attenuated with the help of ApEn's insensitivity to signal disturbance. This method was tested on a real water distribution system data set with various concentration simulation events. Results from the experiment and analysis show that the proposed method has a good performance on noise tolerance and provides a better detection result compared with the autoregressive model and sequential probability ratio test.

Real-time detection of organic contamination events in water distribution systems by principal components analysis of ultraviolet spectral data

The detection of organic contaminants in water distribution systems is essential to protect public health from potential harmful compounds resulting from accidental spills or intentional releases. Existing methods for detecting organic contaminants are based on quantitative analyses such as chemical testing and gas/liquid chromatography, which are time- and reagent-consuming and involve costly maintenance. This study proposes a novel procedure based on discrete wavelet transform and principal component analysis for detecting organic contamination events from ultraviolet spectral data. Firstly, the spectrum of each observation is transformed using discrete wavelet with a coiflet mother wavelet to capture the abrupt change along the wavelength. Principal component analysis is then employed to approximate the spectra based on capture and fusion features. The significant value of Hotelling's T² statistics is calculated and used to detect outliers. An alarm of contamination event is triggered by sequential Bayesian analysis when the outliers appear continuously in several observations. The effectiveness of the proposed procedure is tested on-line using a pilot-scale setup and experimental data.

THz spectral data analysis and components unmixing based on non-negative matrix factorization methods

In many situations the THz spectroscopic data observed from complex samples represent the integrated result of several interrelated variables or feature components acting together. The actual information contained in the original data might be overlapping and there is a necessity to investigate various approaches for model reduction and data unmixing. The development and use of low-rank approximate nonnegative matrix factorization (NMF) and smooth constraint NMF (CNMF) algorithms for feature components extraction and identification in the fields of terahertz time domain spectroscopy (THz-TDS) data analysis are presented. The evolution and convergence properties of NMF and CNMF methods based on sparseness, independence and smoothness constraints for the resulting nonnegative matrix factors are discussed. For general NMF, its cost function is nonconvex and the result is usually susceptible to initialization and noise corruption, and may fall into local minima and lead to unstable decomposition. To reduce these drawbacks, smoothness constraint is introduced to enhance the performance of NMF. The proposed algorithms are evaluated by several THz-TDS data decomposition experiments including a binary system and a ternary system simulating some applications such as medicine tablet inspection. Results show that CNMF is more capable of finding optimal solutions and more robust for random initialization in contrast to NMF. The investigated method is promising for THz data resolution contributing to unknown mixture identification.

Component spectra extraction from terahertz measurements of unknown mixtures

The aim of this work is to extract component spectra from unknown mixtures in the terahertz region. To that end, a method, hard modeling factor analysis (HMFA), was applied to resolve terahertz spectral matrices collected from the unknown mixtures. This method does not require any expertise of the user and allows the consideration of nonlinear effects such as peak variations or peak shifts. It describes the spectra using a peak-based nonlinear mathematic model and builds the component spectra automatically by recombination of the resolved peaks through correlation analysis. Meanwhile, modifications on the method were made to take the features of terahertz spectra into account and to deal with the artificial baseline problem that troubles the extraction process of some terahertz spectra. In order to validate the proposed method, simulated wideband terahertz spectra of binary and ternary systems and experimental terahertz absorption spectra of amino acids mixtures were tested. In each test, not only the number of pure components could be correctly predicted but also the identified pure spectra had a good similarity with the true spectra. Moreover, the proposed method associated the molecular motions with the component extraction, making the identification process more physically meaningful and interpretable compared to other methods. The results indicate that the HMFA method with the modifications can be a practical tool for identifying component terahertz spectra in completely unknown mixtures. This work reports the solution to this kind of problem in the terahertz region for the first time, to the best of the authors' knowledge, and represents a significant advance toward exploring physical or chemical mechanisms of unknown complex systems by terahertz spectroscopy.

Distribution water quality anomaly detection from UV optical sensor monitoring data by integrating principal component analysis with chi-square distribution

The issue of distribution water quality security ensuring is recently attracting global attention due to the potential threat from harmful contaminants. The real-time monitoring based on ultraviolet optical sensors is a promising technique. This method is of reagent-free, low maintenance cost, rapid analysis and wide cover range. However, the ultraviolet absorption spectra are of large size and easily interfered. While within the on-site application, there is almost no prior knowledge like spectral characteristics of potential contaminants before determined. Meanwhile, the concept of normal water quality is also varying due to the operating condition. In this paper, a procedure based on multivariate statistical analysis is proposed to detect distribution water quality anomaly based on ultraviolet optical sensors. Firstly, the principal component analysis is employed to capture the main variety features from the spectral matrix and reduce the dimensionality. A new statistical variable is then constructed and used for evaluating the local outlying degree according to the chi-square distribution in the principal component subspace. The possibility of anomaly of the latest observation is calculated by the accumulation of the outlying degrees from the adjacent previous observations. To develop a more reliable anomaly detection procedure, several key parameters are discussed. By utilizing the proposed methods, the distribution water quality anomalies and the optical abnormal changes can be detected. The contaminants intrusion experiment is conducted in a pilot-scale distribution system by injecting phenol solution. The effectiveness of the proposed procedure is finally testified using the experimental spectral data.

Terahertz spectroscopic investigation of human gastric normal and tumor tissues

Human dehydrated normal and cancerous gastric tissues were measured using transmission time-domain terahertz spectroscopy. Based on the obtained terahertz absorption spectra, the contrasts between the two kinds of tissue were investigated and techniques for automatic identification of cancerous tissue were studied. Distinctive differences were demonstrated in both the shape and amplitude of the absorption spectra between normal and tumor tissue. Additionally, some spectral features in the range of 0.2~0.5 THz and 1~1.5 THz were revealed for all cancerous gastric tissues. To systematically achieve the identification of gastric cancer, principal component analysis combined with t-test was used to extract valuable information indicating the best distinction between the two types. Two clustering approaches, K-means and support vector machine (SVM), were then performed to classify the processed terahertz data into normal and cancerous groups. SVM presented a satisfactory result with less false classification cases. The results of this study implicate the potential of the terahertz technique to detect gastric cancer. The applied data analysis methodology provides a suggestion for automatic discrimination of terahertz spectra in other applications.

A real-time, dynamic early-warning model based on uncertainty analysis and risk assessment for sudden water pollution accidents

A real-time, dynamic, early-warning model (EP-risk model) is proposed to cope with sudden water quality pollution accidents affecting downstream areas with raw-water intakes (denoted as EPs). The EP-risk model outputs the risk level of water pollution at the EP by calculating the likelihood of pollution and evaluating the impact of pollution. A generalized form of the EP-risk model for river pollution accidents based on Monte Carlo simulation, the analytic hierarchy process (AHP) method, and the risk matrix method is proposed. The likelihood of water pollution at the EP is calculated by the Monte Carlo method, which is used for uncertainty analysis of pollutants' transport in rivers. The impact of water pollution at the EP is evaluated by expert knowledge and the results of Monte Carlo simulation based on the analytic hierarchy process. The final risk level of water pollution at the EP is determined by the risk matrix method. A case study of the proposed method is illustrated with a phenol spill accident in China.

An Intelligent Signal Processing Method for High-Speed Weighing System

The dynamic weighing signal processing method in high-speed fruits sorting system directly affects the weighing accuracy. This paper describes a basic modeling method for time series, including modeling, order determining, applicability analysis, and prediction. Considering the structural characteristics of weighing system and the limit of PLC sampling speed, a modified auto-regressive (AR) model for stable value prediction of the high-speed weighing signals is presented. Meanwhile, a simulation base on Matlab platform and an implementation example are used to test the method performance. At last, the impacts of environmental changes, sorting speeds, fruits shapes, and sizes on the method performance are discussed. In experimental conditions, this method can be applied to fruits sorting system with sorting speed up to 18 per second for standard fruit (smooth round surface without defects) and an acceptable weighing accuracy can be obtained.

An Intelligent Signal Processing Method for High Speed Weighing System

The dynamic weighing signal processing method in high speed fruits sorting system directly affects the weighing accuracy. This paper describes a basic modeling method for time series, including modeling, order determining, applicability analysis, and prediction. Considering the structural characteristics of weighing system and the limit of PLC sampling speed, a modified autoregressive (AR) model for stable value prediction of the high speed weighing signals is presented. Meanwhile, a simulation base on Matlab platform and an implementation example are used to test the method performance. At last, the impacts of environmental changes, sorting speeds, fruits shapes and sizes on the method performance are discussed. In experimental conditions, this method can be applied to fruits sorting system with sorting speed up to 18 per second for standard fruit (smooth round surface without defects) and an acceptable weighing accuracy can be obtained.

[Terahertz time-domain spectroscopy of alpha endosulfan persistent organic pollutant]

Frequency-dependent absorption coefficient spectrum and refractive index spectrum of alpha endosulfan, a kind of persistent organic pollutants, are presented in the terahertz frequency region by terahertz (THz) time-domain spectroscopy (TDS). The spectral features in the THz region have a number of unique characteristic absorption peaks. The result demonstrates that THz-TDS is a promising method to identify materials. Then we adopted density functional calculation method to analyze theoretic absorption coefficients of single alpha endosulfan molecule within 0.2-2 THz. The results show that absorption peaks at 1.68, 1.91 THz in theoretical calculation correspond to 1.7, 1.88 THz in the experiment. Finally, vibrational modes and approximate assignments were discussed, showing that these matched peaks are caused by intramolecular vibrational modes of alpha endosulfan. Others might be related to intermolecular vibrational modes or combined vibrational modes.

[Terahertz time-domain spectroscopy of Clenbuterol hydrochloride]

The terahertz spectra of Clenbuterol hydrochloride in the range of 0.2 to 2.6 THz were obtained by THz time-domain spectroscopy, the absorption and refraction spectra of Clenbuterol hydrochloride was got meanwhile. The structure and vibrational frequencies of Clenbuterol molecule, Clenbuterol hydrochloride molecule and Clenbuterol hydrochloride crystal in the THz range were simulated. Based on the difference between experimental and theoretical results, the origin of the vibrational frequencies was analyzed. This study demonstrated the feasibility of time-domain terahertz spectroscopy for the identification of Clenbuterol hydrochloride and provides a new way for the detection of Clenbuterol hydrochloride.

[Terahertz time-domain spectroscopy of ractopamine hydrochloride]

The terahertz spectra of Ractopamine hydrochloride in the range of 0.2 to 2.2 THz was obtained by THz time-domain spectroscopy, and the absorption and refraction spectra of Ractopamine hydrochloride was got meanwhile. The structure and vibrational frequencies of Ractopamine molecule in the THz range were simulated by density functional theory. The difference between experimental and theoretical results was analyzed. And assisted by Gaussian View 3.09, the origin of the vibrational frequencies was recognized. The results show that besides the intramolecular vibrations, THz absorption of Ractopamine hydrochloride originated from the intermolecular hydrogen bond network and Van der Waals force between molecules. This study demonstrated the feasibility of time-domain terahertz spectroscopy for the identification of Ractopamine hydrochloride and provided a new way for the detection of Ractopamine hydrochloride.

Optical characterization of a Cd(0.85)Mg(0.15)Se mixed crystal

We present an optical characterization of a Bridgman-grown wurtzite-type Cd(0.85)Mg(0.15)Se mixed crystal in the near-band-edge interband transitions using temperature-dependent contactless electroreflectance (CER) and photoreflectance (PR) in the temperature range 15-400 K. The interband excitonic transitions A and C originating from the band edge and spin-orbital splitting critical points of the sample, respectively, have been observed in the CER/PR spectra. The transition energies and broadening function of the excitonic features are determined via a lineshape fit to the CER/PR spectra. The parameters that describe the temperature dependence of the transition energies of excitons A and C, and the broadening function of exciton A, are evaluated and discussed.

Inversion of thicknesses of multi-layered structures from eddy current testing measurements

Luquire et al.'s impedance change model of a rectangular cross section probe coil above a structure with an arbitrary number of parallel layers was used to study the principle of measuring thicknesses of multi-layered structures in terms of eddy current testing voltage measurements. An experimental system for multi-layered thickness measurement was developed and several fitting models to formulate the relationships between detected impedance/voltage measurements and thickness are put forward using least square method. The determination of multi-layered thicknesses was investigated after inversing the voltage outputs of the detecting system. The best fitting and inversion models are presented.

Efficacy and safety of imidapril in patients with essential hypertension: a double-blind comparison with captopril

In this 12-week, double-blind, parallel-group, comparative trial, 57 adult patients with mild-to-moderate hypertension were randomly allocated to receive imidapril or captopril, initially at a dose of 5 mg once a day and 25 mg twice daily, respectively. After 4 weeks of therapy, the dose of each drug was increased twice if diastolic blood pressure (DBP) remained > or =90 mm Hg. Both treatments effectively lowered DBP in a comparable manner. Mean changes from baseline in DBP at 12 weeks were -9.9 mm Hg for imidapril and -8.8 mm Hg for captopril (p = 0.488). Responder rates in patients receiving active treatment for at least 6 weeks were 53.9% for imidapril and 48% for captopril (p = 0.676). Both treatments were well tolerated. Adverse drug reactions were observed in 20.7% (6/29) of the imidapril group and 46.4% (13/28) of the captopril group (p < 0.05). A cough was the most frequent side effect, reported in 13.8% of the imidapril group and 35.7% of the captopril group. The results indicate that imidapril is as effective as captopril in the treatment of hypertension. Imidapril produces less adverse effects compared with captopril.

Spontaneous femoral neck fracture complicating a healed subtrochanteric fracture--a case report

A rare case of spontaneous femoral neck fracture complicating a healed subtrochanteric fracture was encountered in an 85-year-old female. The subtrochanteric fracture was caused by a minor trauma with no other combined injury. Patient received close reduction and internal fixation two days later and the fracture healed in three months. Six months after operation, spontaneous ispilateral femoral neck fracture occurred without trauma. Although there were some reports about subcapital fracture or femur neck fracture complication after operation, this is the first case of spontaneous femoral neck fracture after healed subtrochanteric fracture which was treated with a 95 degrees dynamic condylar screw (DCS) and side plate previously without technical error.

Inhomogeneity of myocardial perfusion in heart transplant recipients: evaluation with dobutamine thallium-201 SPECT

Progressive heterogeneity of thallium-201 single photon emission computed tomography (Tl-201 SPECT) in heart transplant recipients has been documented in Caucasians. However, in Chinese heart transplant recipients, a lower incidence of transplant coronary artery disease (CAD) has been noted than in Western transplant recipients. In this study, we examine whether heterogeneity of Tl-201 SPECT exists in Chinese transplant recipients. Dobutamine Tl-201 SPECT was performed in 40 heart transplant recipients and the inhomogeneity scores were calculated. The difference between the scores of transplant recipients surviving less than 12 months and those of control subjects were not statistically significant. One year after transplantation, the inhomogeneity score increased progressively. The scores of transplant patients in the second and third years after transplant were similar to those of single-vessel CAD patients. Three years after transplant the scores were greatly increased. Thus, our data suggest that the progressive nature of graft vasculopathy also exists in Chinese heart transplant recipients. The progressive Tl-201 abnormalities may be one of the early signs of graft vasculopathy.

Surgical treatment for Haglund's deformity

Haglund's deformity, or "pump bump" is a common cause of posterior heel pain, characterized clinically by a painful soft tissue swelling at the level of the Achilles tendon insertion. We reviewed 30 heels in 19 patients with failure of conservative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity and bursectomy through a medial longitudinal incision. The average follow-up period was 6 years (range, 3-10 years). Only 3 heels (10%) in 2 patients had persistent pain. Twenty-seven heels (90%) were cured after operation. However, 25 heels (83%) had residual pain for a half to two years after operation and became free of symptoms thereafter. We conclude surgical treatment of Haglund's deformity produces a predictably good result (90%) but requires a long time about a half to two years for full recovery.

Isolated talonavicular arthrodesis for talonavicular arthritis

We have reviewed a single surgeon's experience with isolated talonavicular fusion in 16 patients with talonavicular arthritis. Fixation was either by staples or screws. Fifteen solid unions were achieved in the 16 patients who were followed (mean: 51 months). The average Ankle-Hindfoot Scale improved from 77.2 preoperatively to 92.9 postoperatively (p < 0.001). Subjectively, 15 patients were satisfied and one patient dissatisfied with the results. Further osteoarthritis in the adjacent joints was noted in five patients. We concluded that isolated talonavicular fusion is an effective method of treatment of talonavicular arthritis regarding pain relief and functional improvement. Though osteoarthritis was found in some adjacent joints postoperatively, the results were still satisfactory.

Accuracy of biphasic response, sustained improvement and worsening during dobutamine echocardiography in predicting recovery of resting myocardial dysfunction after revascularization: comparison with thallium-201 SPECT

To evaluate the accuracy of various types of wall motion response during dobutamine echocardiography (DE) in predicting functional recovery after revascularization, we studied 30 patients with stable coronary disease and left ventricular dysfunction by simultaneous DE and (201)Tl reinjection SPECT. Among 480 segments (16 segments/patient), 199 had abnormal wall motion at baseline and 167 were revascularized. The predictive value for recovery of function was 72% for a biphasic response, 61% for sustained improvement, 77% for worsening, and 27% for no change (p < 0.01 vs. each). Biphasic response had a sensitivity of 40% and specificity of 85%. Combining biphasic, sustained improvement and worsening responses, the sensitivity, specificity and accuracy were 76%, 65% and 71%, respectively. For (201)Tl SPECT, they were 90%, 65% and 78%, respectively. Thus, a biphasic response alone is of low sensitivity. Combination of biphasic, sustained improvement and worsening responses gives an accuracy rate comparable to that of (201)Tl reinjection SPECT in assessing functional recovery.

Low tibial osteotomy for moderate ankle arthritis

Low tibial osteotomy is one of the significant advances of ankle reconstruction techniques that has been made recently in an effort to halt arthritis in its early stages and leave fusion as the last, not the only, alternative treatment of ankle arthritis. From 1989 to 1995, we performed 18 low tibial osteotomies which included 6 cases of post-traumatic arthritis and 12 cases of degenerative arthritis. The ages of the 7 male and 11 female patients ranged from 18 to 78 years with an average of 41.9 years. The follow-up period lasted a mean of 47.7 months, ranging from 25 to 82 months. The average functional score changed from 49.6 pre-operatively to 88.5 at the last follow up, and showed yearly improvement. Complications included one case of late infection and two cases of implant failure, none of which led to nonunion. The indication for low tibial osteotomy is the intermediate stage of moderate ankle arthritis with a medial joint lesion and intact lateral facet. Using pressure redistribution on the joint surface, this procedure is an alternative treatment for ankle arthritis which may save an arthritic ankle from the fate of fusion or at least postpone fusion surgery.

Comparison of ischemic patterns in myocardial bridge and syndrome X: evaluation by dobutamine stress echocardiography and stress thallium-201 SPECT

BACKGROUND AND PURPOSE

Ischemic patterns in patients with syndrome X are thought to differ from those in patients with myocardial bridge, because the mechanisms of coronary flow reduction in these two diseases are different. The aim of this study was to compare the ischemic patterns in patients with syndrome X and those with myocardial bridge through the use of dobutamine stress echocardiography (DSE) and stress thallium-201 single-photon emission computed tomography (SPECT).

METHODS

Twenty-six patients with typical angina and stress-induced ST-segment depression were enrolled. All patients underwent coronary angiography, DSE, and stress thallium-201 SPECT within 7 days after enrollment.

RESULTS

Of the 26 patients enrolled, 10 had myocardial bridge of the left anterior descending artery and 16 had syndrome X. Among patients with myocardial bridge, myocardial dyssynergy was found by DSE in five patients and reversible or fixed thallium-201 perfusion defects were found in four. Seven patients with myocardial bridge had reverse redistribution patterns on thallium-201 scintigraphy. In the 16 patients with syndrome X, myocardial dyssynergy was found by DSE in only one patient (p = 0.018 vs myocardial bridge group) and reversible or fixed thallium-201 perfusion defects were found in nine (p > 0.05 vs myocardial bridge group). Four patients with syndrome X had reverse redistribution patterns on thallium-201 scintigraphy. The resting left ventricular end-diastolic pressure was higher in patients with myocardial bridge than in those with syndrome X (17 +/- 4 vs 12 +/- 5 mm Hg, p = 0.02).

CONCLUSIONS

The most common ischemic patterns in patients with syndrome X were chest pain and stress-induced ST-segment depression, followed by myocardial perfusion defects. Dobutamine-induced dyssynergy was rare. Left ventricular end-diastolic pressure elevation and dobutamine-induced wall motion abnormalities were more common in patients with myocardial bridge than in those with syndrome X.

Assessment of the myocardial changes in heart transplant recipients without evident acute myocardial rejection by integrated backscatter: comparison with simultaneous dobutamine stress echocardiography and (201)thallium spect

Cardiomyocyte hypertrophy and interstitial fibrin deposition develop in cardiac allografts and contribute to the functional changes of transplanted hearts. We hypothesized that integrated backscatter (IBS) can detect these myocardial changes. A total of 32 heart transplant recipients with either no or mild acute rejection (International Society of Heart and Lung Transplantation grade IA) were enrolled in this study. IBS data of myocardium were collected immediately before simultaneous dobutamine stress echocardiography (DSE) and (201)thallium imaging. Coronary angiography and endomyocardial biopsy were also performed. Coronary angiography showed diffuse narrowing in 1 patient who also had abnormal results of IBS, DSE, and thallium results. In the other 31 patients with patent coronary arteries, there were 3 patients (10%) with abnormal DSE results, 19 patients (61%) with abnormal IBS patterns, and 16 patients (52%) with reversible thallium perfusion defects. Of the patients, 44% had cardiomyocyte hypertrophy and 56% interstitial fibrin deposition. There were significant differences in the prevalence of (201)thallium perfusion defects and serum cyclosporine levels between patients with and without abnormal IBS patterns. Pathologic changes were also associated with abnormal IBS patterns (p = 0.01). However, there was no association between abnormal IBS and DSE results. By multiple logistic regression analysis, the abnormal IBS patterns were associated inversely with serum cyclosporine level (p = 0.028). In conclusion, abnormal IBS patterns are associated significantly with perfusion heterogeneity and pathologic changes in heart transplant recipients without evident acute myocardial rejection. There is no association between abnormal IBS patterns and dobutamine-induced dyssynergy in these patients. IBS provides a noninvasive approach for detection of myocardial changes in transplanted hearts without evident acute rejection.

Integrated backscatter for quantification and risk stratification of blood stagnation in left atrial appendages of patients with rheumatic mitral stenosis

This study was designed to quantify the blood stagnation in left atrial appendages (LAA) of patients with rheumatic mitral stenosis, and to stratify the risk of spontaneous echo contrast (SEC) for thrombus formation. A total of 45 patients were enrolled in this study. Thirty of the 45 patients had rheumatic mitral stenosis. All the above patients were evaluated for LAA contractility by transesophageal echocardiography. Acoustic density of the stagnant blood was assessed using the integrated backscatter (IBS) mode. Multivariate linear regression analysis showed that the significant independent variables determining relative IBS in LAA were the mitral valve area (p = 0.02) and the atrial fibrillation rhythm (p = 0.0003). In patients with mitral stenosis, the IBS in LAA correlated well with the presence of thrombus (p = 0.004) and SEC (p = 0.002). Using the relative IBS in LAA with 6.8 dB as the cutoff value, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SEC formation in LAA was 83, 86, 95, 60 and 83%, respectively. Using the relative IBS in LAA with 10.0 dB as the cutoff value, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SEC with thrombus formation in LAA was 80, 80, 67, 89 and 80%, respectively. In conclusion, the blood stasis in LAA can be objectively quantified using IBS. Utilizing different cutoff values, the acoustic densitometry in LAA enables identification of stagnant blood which represents a risk for the development of either SEC only or SEC with thrombus formation.

Comparison of simultaneous dobutamine echocardiography and thallium-201 stress-reinjection single-photon emission computed tomography in predicting improvement of chronic myocardial dysfunction after revascularization

Previous studies have shown that ultrasonic integrated backscatter is valuable in characterizing stunned myocardium. Recent investigations have demonstrated that resting cardiac cycle-dependent variation of integrated backscatter closely paralleled the contractile reserve in patients with chronic left ventricular ischemic dysfunction. The purpose of this study was to validate whether ultrasonic tissue characterization (UTC) compared with dobutamine stress echocardiography (DSE) and thallium-201 stress-reinjection single-photon emission computed tomography (Tl-SPECT) could predict reversible myocardial dyssynergy in patients with chronic coronary artery disease. Forty-eight patients with stable coronary artery disease underwent UTC, DSE, and Tl-SPECT simultaneously before successful coronary revascularization and were followed up with echocardiograms at rest >3 months later. Among the 58 investigated segments, the weighted amplitude, a composite parameter derived from the integrated backscatter power curve, was larger for those groups with greater functional recovery (p <0.001). For the persistent akinetic segments, the weighted amplitudes were small with large deviations of the nadir ratios that represented the asynchrony between the intramural contractile events and the global systole. Using the cut-off value 2.0 of the weighted amplitude, the sensitivity and specificity for predicting functional improvement after revascularization were both 82.8% (kappa = 0.66) and comparable to the sensitivity and specificity of DSE and Tl-SPECT. UTC, delineating the myocardial physical state and intramural contraction, can be a novel approach in predicting functional improvement of chronic dyssynergy after revascularization.

High glucose-induced apoptosis in human endothelial cells is mediated by sequential activations of c-Jun NH(2)-terminal kinase and caspase-3

BACKGROUND

Diabetes mellitus causes multiple cardiovascular complications. High glucose can induce reactive oxygen species and apoptosis in endothelial cells. Little is known about the molecular mechanisms in high glucose-induced endothelial cell apoptosis.

METHODS AND RESULTS

We elucidated the signaling pathway of high glucose-induced apoptosis in human umbilical vein endothelial cells (HUVECs). HUVECs were treated with media containing 5.5, 19, or 33 mmol/L of glucose in the presence or absence of an antioxidant, ascorbic acid. The level of intracellular H(2)O(2) was measured by flow cytometry. For detection of apoptosis, the cell death detection ELISA assay and the morphological Hoechst staining were used. High glucose was capable of inducing the activity of c-Jun NH(2)-terminal kinase (JNK) but not extracellular signal-regulated kinase 1/2 or p38 mitogen-activated protein kinase during the treatment periods, as evidenced by immunocomplex kinase assay. Moreover, we found that the interleukin 1beta-converting enzyme (ICE)/CED-3 family protease (caspase-3) became activated in high glucose-induced apoptosis. Caspase-3/CPP32-specific inhibitor, Ac-DEVD-CHO, could inhibit high glucose-induced apoptosis. Furthermore, we found that JNK1 specific antisense oligonucleotide could suppress caspase-3 activity but not affect H(2)O(2) generation and could block apoptosis induced by high glucose. Also, H(2)O(2) generation, JNK activity, caspase-3 activity, and the subsequent apoptosis induced by high glucose could be suppressed by ascorbic acid.

CONCLUSIONS

The present study indicates that reactive oxygen species induced by high glucose may be involved in JNK activation, which in turn triggers the caspase-3 that facilitates the apoptosis in HUVECs.

Ultrasonic tissue characterization evaluates myocardial viability and ischemia in patients with coronary artery disease

To evaluate whether or not ultrasonic tissue characterization (UTC) can detect jeopardized or salvageable myocardium in patients having chronic coronary artery disease, we studied 103 patients with sequential UTC, dobutamine stress echocardiography (DSE) and (201)thallium stress-reinjection single-photon emission computed tomography (T1-SPECT). This revealed that the weighted amplitude of the cyclic modulation of integrated backscatter was larger for the myocardium with less ischemia burden or greater viability (p<0.001). The segments with larger ischemia burden or the nonviable myocardium demonstrated the contrary result. Using the receiver-operating characteristic curve analyses to determine the cutoff value of weighted amplitude for various predictions, UTC can detect ischemia in normokinetic myocardium (kappa = 0.34 compared to DSE or T1-SPECT) and viability in dyssynergic myocardium (kappa = 0.57 compared to DSE and 0.45, to T1-SPECT). These observations show that UTC may prove useful in the identification and pathophysiological understanding of myocardial ischemia and viability.

Open total talar dislocation--report of two cases

Total dislocation of talus from all its surrounding joints (tibiotalar, subtalar and talonavicular) is an extremely rare injury. Because of its rarity, only few case reports can be found in the literature. In the review of the literature, infection and AVN are the most commonly encountered complications that affect the outcome of these severe injuries. Herein we report two cases of open total talar dislocation. Immediate debridement, reduction of the talus, and primary skin closure was done followed by cast immobilization. After more than 2 years follow up, neither infection nor AVN was found. We conclude that reimplantation of the talus is preferable if the wound is relatively clean. Talectomy, or combined with tibiocalcaneal fusion should be reserved for later salvage procedure.

Postero-medio-anterior approach of the ankle for the pilon fracture

A good view of the operative field is important for better reduction and fixation in surgical treatment of fractures. The exposure of the ankle joint for the pilon fracture is commonly through the anterior approach, or combined with the medical approach. But sometimes it is still difficult to have complete viewing of the articular surface and to apply internal fixation by that approach. In recent years, we developed a "postero-medio-anterior" approach of the ankle joint by one incision. This approach provides an excellent exposure of the anterior, medial and posterior aspects of the ankle joint with a clear view of the articular surface. In our 45 cases of pilon fracture during 1991 to 1995, there was no incisional injury to the neurovascular bundle. Superficial wound edge necrosis was noted in two cases which healed later without further procedure. Therefore, we recommend this approach as a simple and reliable incision for open reduction of pilon fractures.

The surgical treatment for degenerative disease of the ankle

Although a variety of surgical techniques are available for the surgical treatment of early degenerative disease of the ankle, arthrodesis remains the preferred treatment for severe cases. We studied 126 ankles with an average follow up of 39 months of whom 25 with early disease underwent debridement and cheilectomy, 18 with intermediate disease underwent lower tibial osteotomy and 83 with severe disease underwent either arthrodesis (78) or total ankle replacement (5). In 96% of cases there was a satisfactory functional outcome.

Persistent myocardial ischemia after termination of dipyridamole-induced ventricular tachycardia by intravenous aminophylline: scintigraphic demonstration

Ventricular tachycardia is a rare complication of dipyridamole stress testing. We present a case in which dipyridamole induced symptomatic ventricular tachycardia. The patient, a 41-year-old man with a history of chest discomfort on exertion for 1 year, underwent dipyridamole thallium imaging. Sustained ventricular tachycardia occurred 1 minute and 40 seconds after completion of the dipyridamole infusion. Intravenous aminophylline (125 mg) was given immediately and the tachycardia was terminated. Two minutes later, thallium-201 was injected and subsequent myocardial imaging showed reversible perfusion defects in the inferior wall, septum, and apex. Coronary angiography revealed three-vessel disease. This case discloses that reversible perfusion defects can still be demonstrated on thallium scan in spite of injection of aminophylline, an antagonist of dipyridamole, before thallium administration.

Gait analysis after ankle arthrodesis

The purpose of this study was to employ a computerized motion analysis system to identify the effect of ankle arthrodesis on the three-dimensional kinematic behavior of the rear and fore foot during level walking. A three-segment rigid body model was used to describe the motion of the foot and ankle. The results demonstrated that sagittal plane motion of the hindfoot was significantly decreased in the foot of patients having had ankle arthrodesis compared to normal subjects. The kinematic data indicated a generalized stiffness of the hindfoot on the involved foot in the sagittal plane. Sagittal plane movement in the forefoot and transverse plane movements in the hindfoot and forefoot increased in patients compared to controls.

Nitric oxide prevents apoptosis of human endothelial cells from high glucose exposure during early stage

Hyperglycemia is a major cause of diabetic vascular disease. High glucose can induce reactive oxygen species (ROS) and nitric oxide (NO) generation, which can subsequently induce endothelial dysfunction. High glucose is also capable of triggering endothelial cell apoptosis. Little is known about the molecular mechanisms and the role of ROS and NO in high glucose-induced endothelial cell apoptosis. This study was designed to determine the involvement of ROS and NO in high glucose-induced endothelial cell apoptosis. Expression of endothelial nitric oxide synthase (eNOS) protein and apoptosis were studied in cultured human umbilical vein endothelial cells (HUVECs) exposed to control-level (5.5 mM) and high-level (33 mM) glucose at various periods (e.g., 2, 12, 24, 48 h). We also examined the effect of high glucose on H(2)O(2) production using flow cytometry. The results showed that eNOS protein expression was up-regulated by high glucose exposure for 2-6 h and gradually reduced after longer exposure in HUVECs. H(2)O(2) production and apoptosis, which can be reversed by vitamin C and NO donor (sodium nitroprusside), but enhanced by NOS inhibitor (N(G)-nitro-L-arginine methyl ether), were collated to a different time course (24-48 h) to HUVECs. These results provide the molecular basis for understanding that NO plays a protective role from apoptosis of HUVECs during the early stage (<24 h) of high glucose exposure, but in the late stage (>24 h), high glucose exposure leads to the imbalance of NO and ROS, resulting to the observed apoptosis. This may explain, at least in part, the impaired endothelial function and vascular complication of diabetic mellitus that would occur at late stages.

Effect of acupuncture at nei-kuan on left ventricular function in patients with coronary artery disease

Effect of acupuncture at Nei-Kuan (EH-6) on left ventricular ejection fraction (LVEF) was examined in 22 patients with angiographically proved coronary artery disease (CAD) and 22 normal subjects. Serial equilibrium radionuclide angiography was done to measure LVEF at 4 different times (at baseline, at 1 to 15 minutes, and 16 to 30 minutes during acupuncture, and immediately after acupuncture). One week later, each patient had an identical imaging protocol with acupuncture performed at a dummy point. Our results showed that in normal subjects, the mean values of LVEF did not change significantly during or after acupuncture. In contrast, in patients with CAD, the mean values of LVEF in the initial 15 minutes of acupuncture significantly increased from baseline (42.5 +/- 15.6% vs. 40.6 +/- 15.4%, p < 0.05). The increase persisted through the next 15 minutes of acupuncture and 15 minutes after acupuncture, but became insignificant at one week. Thus, acupuncture at Nei-Kuan can temporarily improve LV function in patients with CAD.

Ankle arthrodesis: internal non-compression arthrodesis versus internal compression arthrodesis

Ankle arthrodesis is still considered to be the standard treatment for most disabling types of ankle arthritis, but fusion methods are varied. We report our experience of ankle arthrodesis and compare a group of 34 cases treated by Blair's non-compression arthrodesis to another group of 32 cases treated by internal compression arthrodesis using two crossed screws. The same surgeon performed all the operations. The Blair's non-compression arthrodesis group included 21 males and 13 females with an average age of 42 y/o (range 18-70 y/o) and an average follow up period of 38.6 months (range 26-62 months). The union rate was 91.2% and the average union time was 5.6 months (range 2-10 months). There were three cases of non-union. The cross-screw compression arthrodesis group included 20 males and 12 females with an average age of 45 y/o (range 20-86 y/o) and an average follow up period of 38.3 months (range 15-81 months). The union rate was 96.9% and the average union time was 2.7 months (range 1.5-4.4 months). There was one case of non-union. We conclude that our cross-screws compression arthrodesis with its shorter fusion time was found to be superior to the Blair's non-compression arthrodesis.

Significance of dobutamine-induced ST-segment evaluation and T-wave pseudonormalization in patients with Q-wave myocardial infarction: simultaneous evaluation by dobutamine stress echocardiography and thallium-201 SPECT

The clinical significance of stress-induced ST-segment elevation and T-wave pseudonormalization in infarct-related leads is still controversial. Therefore, we conducted the present study to assess this issue using simultaneous dobutamine stress echocardiography (DSE) and thallium-201 single-photon emission computed tomography. A total of 119 patients with Q-wave myocardial infarction were enrolled in this study. There were 58 patients with (group I) and 61 patients without (group II) dobutamine-induced ST-T changes. Left ventricular ejection fraction was 43 +/- 13% in group I and 49 +/- 14% in group II (p <0.05). The baseline, low-, and peak-dose global wall motion scores were similar between these 2 groups (26.2 +/- 6.1 vs 26.2 +/- 6.3 [p = NS]; 24.1 +/- 5.3 vs 23.5 +/- 5.7 [p = NS]; 26.4 +/- 5.7 vs 26.7 +/- 6.1 [p = NS]). The sensitivity, specificity, and accuracy of these ST-T changes for detecting residual myocardial viability and ischemia documented by DSE in all patients were 50%, 53%, and 51% (for viability), and 47%, 48%, and 47% (for ischemia), respectively. The sensitivity, specificity, and accuracy of these ST-T changes for detecting a reversible perfusion defect documented by thallium-201 single-photon emission computed tomography were 51%, 54%, and 52%, respectively. In conclusion, dobutamine-induced ST elevation and/or T-wave pseudonormalization is associated with poor resting left ventricular function. These ST-T changes are not associated with residual myocardial ischemia and viability in the infarct area. Therefore, these electrocardiographic changes alone cannot be reliably considered as distinctive markers in formulating the therapeutic strategy of coronary intervention.

Subtalar arthrodesis for late sequelae of calcaneal fractures: fusion in situ versus fusion with sliding corrective osteotomy

Primary subtalar arthritis is not common. In most cases, it is the late sequela of intra-articular calcaneal fracture. Subtalar arthrodesis is mostly used for the treatment of traumatic subtalar arthritis in our clinics. We have compared our early cases of in-situ subtalar fusion with our recent cases of fusion with sliding corrective osteotomy in this clinical report. From 1989 to 1992, 15 feet of 13 patients were treated with subtalar arthrodeses for subtalar arthritis caused by malunion of calcaneal fractures. Fusion in situ was done by Ollier's approach, and resection of bony protrusion was done if there was lateral entrapment syndrome. From 1992 to 1995, 13 feet of 12 patients also received subtalar arthrodeses to salvage their calcaneal fractures, but the subtalar fusion was done by wide lateral approach, calcaneal sliding corrective osteotomy, and sometimes (11 of 13 feet) with Achilles tendon lengthening to restore the calcaneal height and width. Patients of both groups experienced obvious clinical improvement in subtalar pain relief, but there was no difference with walking distance, running, or jumping. The group undergoing fusion with sliding corrective osteotomy was more satisfied with regard to cosmetic results and shoe wear. The overall satisfactory rate in the group who underwent fusion with sliding corrective osteotomy (92%) was superior to the group who underwent fusion in situ (77%). Though our method of sliding corrective osteotomy does not provide much improvement to the talus declination angle, it is suitable for those patients with a "banana"-shaped calcaneus malunion. If the patient has prominent anterior ankle pain caused by tibiotalar impingement, we believe that a distraction subtalar arthrodesis would be more appropriate.