Ameloblastoma, desmoplastic type: a case report with characteristic radiological presentation

Ameloblastoma, desmoplastic type, is a rare lesion for which radiographic images are even less common, and such lesions are sometimes considered to be variant types. It is defined as a variant of ameloblastoma with specific imaging and histological features. This lesion occurs with the same frequency in the maxilla and mandible, although the predominant site is the anterior-premolar site in both the mandible and maxilla. For our case of ameloblastoma, desmoplastic type, resected from the right anterior to premolar maxilla, the radiographic appearance and histopathological findings were compared. Computed tomography images revealed that the lesion had a multilocular structure with many smaller septa at its periphery. Although expansion toward the maxillary sinus was suggested radiologically, invasion of the mucosa into the floor of the maxillary sinus was found on histopathological examination.     

Discrimination between schizophrenia and major depressive disorder by magnetic resonance imaging of the female brain

Background

Although schizophrenia and major depressive disorder (MDD) differ on a variety of neuroanatomical measures, a diagnostic tool to discriminate these disorders has not yet been established. We tried to identify structural changes of the brain that best discriminate between schizophrenia and MDD on the basis of gray matter volume, ventricle volume, and diffusion tensor imaging (DTI).

Method

The first exploration sample consisted of 25 female patients with schizophrenia and 25 females with MDD. Regional brain volumes and fractional anisotropy (FA) values were entered into a discriminant analysis. The second validation sample consisted of 18 female schizophrenia and 16 female MDD patients.

Results

The stepwise discriminant analysis resulted in correct classification rates of 0.80 in the schizophrenic group and 0.76 in MDD. In the second validation sample, the obtained model yielded correct classification rates of 0.72 in the schizophrenia group and 0.88 in the MDD group.

Conclusion

Our results suggest that schizophrenia and MDD have differential structural changes in the examined brain regions and that the obtained discriminant score may be useful to discriminate the two disorders.     

Relationship between mortality and rice cadmium concentration in inhabitants of the polluted Jinzu River basin,Toyama, Japan: A 26 year follow‐up

The aim of this study was to investigate the relationship between mortality and rice cadmium (Cd) concentration in inhabitants of a polluted area in Japan. The target subjects were inhabitants of the Jinzu River basin who participated in health examinations for screening of renal dysfunction from 1979 to 1984. The mean rice Cd concentration in each hamlet was used as an index of the Cd exposure. We conducted a 26 year follow‐up survey in 3281 inhabitants (1544 men and 1737 women) whose data regarding the rice Cd concentration were available. Mortality risk ratios for all and specific causes were estimated after adjustments for age at baseline, smoking status and history of hypertension using a Cox hazard model or Fine and Gray competing risks regression model. The mortality risk ratios of rice Cd concentration (+0.1 ppm) for all causes in women were significantly increased (risk ratio: 1.04). Furthermore, the relative risks of rice Cd concentration for kidney and urinary tract disease, renal diseases, renal failure and toxic effects of cadmium were significantly increased in both sexes. These findings indicated that increased rice Cd concentration decreased the prognosis for life over a long‐term observation in women. This result provides important information for determining the worldwide standard for allowable rice Cd concentration.     

Optimal cannula positioning of HeartMate 3 left ventricular assist device

Cannula position in HeartMate II and HeartWare left ventricular assist devices (LVADs) is associated with clinical outcome. This study aimed to investigate the clinical implication of the device positioning in HeartMate 3 LVAD cohort. Consecutive patients who underwent HeartMate 3 LVAD implantation were followed for one year from index discharge. At index discharge, chest X-ray parameters were measured: (a) cannula coronal angle, (b) height of pump bottom, (c) cannula sagittal angle, and (d) cannula lumen area. The association of each measurement of cannula position with one-year clinical outcomes was investigated. Sixty-four HeartMate 3 LVAD patients (58 years old, 64% male) were enrolled. In the multivariable Cox regression model, the cannula coronal angle was a significant predictor of death or heart failure readmission (hazard ratio 1.27 [1.01-1.60], P = .045). Patients with a cannula coronal angle ≤28° had lower central venous pressure (P = .030), lower pulmonary capillary wedge pressure (P = .027), and smaller left ventricular size (P = .019) compared to those with the angle >28°. Right ventricular size and parameters of right ventricular function were also better in the narrow angle group, as was one-year cumulative incidence of death or heart failure readmission (10% vs. 50%, P = .008). Narrow cannula coronal angle in patients with HeartMate 3 LVADs was associated with improved cardiac unloading and lower incidence of death or heart failure readmission. Larger studies to confirm the implication of optimal device positioning are warranted.     

Aromatase-knockout mouse carrying an estrogen-inducible enhanced green fluorescent protein gene facilitates detection of estrogen actions in vivo

Aromatase is an enzyme that converts androgen to estrogen in the gonads and also at extragonadal sites, including the brain. In this study we developed a transgenic mouse that carries an enhanced green fluorescent protein (EGFP) gene inducible by estrogen through an estrogen response element to facilitate detection of estrogen actions in vivo. The expression of EGFP in aromatase-deficient (Ar(-/-)) female mice was significantly suppressed at the pituitary gland, ovary, uterus, and gonadal fat pad and was induced by dietary 17beta-estradiol to wild-type (Ar(+/+)) levels or higher. These results demonstrate that the expression of the EGFP gene is tissue selective and estrogen dependent in vivo. Employing this transgenic mouse, we examined whether estrogen synthesis in the extragonadal sites is necessary for reproduction in female mice. When ovaries of Ar(-/-) mice were replaced with Ar(+/+) ovaries, a significant induction of EGFP expression in the pituitary gland and uterus was observed. Histological examinations showed the presence of antral follicles in the replaced ovaries, indicating that the transplants are functional in Ar(-/-) mice. After crossing with males, three of 10 Ar(-/-)females with Ar(+/+) ovaries became pregnant and fed their pups. Collectively, these observations indicate that estrogen synthesis in the ovary is sufficient for supporting female reproduction, and that infertility of Ar(-/-) females is primarily due to a defect in estrogen synthesis in the ovary.     

Electrocardiographic characteristics of the variants of idiopathic left ventricular outflow tract ventricular tachyarrhythmias

Background: Despite similar QRS morphology, idiopathic repetitive monomorphic ventricular tachyarrhythmias (VTs) of left ventricular outflow tract (LVOT) are known to have the variants of different adjacent origins, including the aorto-mitral continuity (AMC), anterior site around the mitral annulus (MA), aortic sinus cusps (ASC), and epicardium. However, the electrocardiographic characteristics of those variants previously have not been evaluated fully.
Methods and Results: Based on the mapping site and successful ablation in 45 consecutive patients with LVOT-VTs, we classified them into VTs of AMC (n = 3), MA (n = 8), ASC (n = 32), and epicardial (n = 2) origins. In all patients, we performed activation mapping and an electrocardiographic analysis. All AMC-VTs patients had monophasic R waves in almost all the precordial leads, while those with anterior MA-VTs had an Rs pattern in some precordial leads except for lead V6, and those with ASC-VTs had a variable transitional zone in leads V1–4. There was no S wave in lead V6 in any group except for one patient with anterior MA-VTs. The intrinsicoid deflection time in the AMC-VTs patients and anterior MA-VTs patients was significantly greater than in those with ASC-VTs (P < 0.05). There was no significant difference in the R-wave amplitude in the inferior leads among the groups. Successful radiofrequency catheter ablation (RFCA) was achieved in all patients except for in those with epicardial origin VT.
Conclusions: Despite many morphological similarities, the LVOT-VTs originating from the AMC, anterior MA and ASC could be identified by our proposed electrocardiographic characteristics in order to safely perform RFCA.     

Association of Gln222Arg polymorphism in the deoxyribonuclease I (DNase I) gene with myocardial infarction in Japanese patients.

AIMS: We have recently reported that serum deoxyribonuclease I (DNase I) activity, which may be involved in apoptosis, increases abruptly in the early phase of acute myocardial infarction (MI) [Kawai Y, Yoshida M, Arakawa K, Kumamoto T, Morikawa N, Masamura K, Tada H, Ito S, Hoshizaki H, Oshima S, Taniguchi K, Terasawa H, Miyamori I, Kishi K, Yasuda T. Diagnostic use of serum deoxyribonuclease I activity as a novel early-phase marker in acute myocardial infarction. Circulation 2004;109:2398-2400]. Death of vascular smooth muscle cells, in part because of apoptosis, is postulated to heighten susceptibility to disruption of vulnerable plaque, resulting in onset of MI. The present study evaluated the possibility that Gln222Arg polymorphism of the DNase I gene may be one of the factors involved in predisposition to MI. METHODS AND RESULTS: We assessed 611 Japanese patients: 311 with MI and 300 with stable angina pectoris (AP). Three common phenotypes determined by two common codominant alleles, DNASE1*1 and *2, whose corresponding gene products exhibit different properties, were found in these patient groups. The prevalence of DNASE1*2 was significantly higher in patients with MI than in those with AP (0.543 vs. 0.428, P < 0.001), being confirmed by phenotyping of the second study population. Multiple logistic regression analysis showed that the odds ratio of DNASE1*2 was 1.51 [95% confidence interval (CI) 1.04-2.18]. The association of the DNASE1*2 allele with MI was statistically significant, being independent of other conventional risk factors. CONCLUSION: Our data demonstrate that Gln222Arg polymorphism in the DNase I gene is associated with MI in the Japanese patients.