Three-dimensional stereotactic surface projection of brain perfusion SPECT improves diagnosis of Alzheimer’s disease

OBJECTIVES: Alzheimer's disease (AD) is diagnosed by either inspection of the brain perfusion SPECT, or three-dimensional stereotactic surface display (3D-SSP). The purpose was to compare diagnostic performances of these methods. METHODS: Sixteen nuclear medicine physicians independently interpreted 99mTc-ECD SPECT in one session and SPECT with 3D-SSP in another session without clinical information for 50 studies of AD patients and 40 studies of healthy volunteers. Probabilities of AD were reported according to a subjective scale from 0% (normal) to 100% (definite AD). Receiver operating characteristics curves were generated to calculate areas under the ROC curves (Az's) for the inspection as well as for an automated diagnosis based on a mean Z value in the bilateral posterior cingulate gyri in a 3D-SSP template. RESULTS: Mean Az for visual interpretation of SPECT alone (0.679 +/- 0.058) was significantly smaller than that for visual interpretation of both SPECT and 3D-SSP (0.778 +/- 0.060). Az for the automated diagnosis (0.883 +/- 0.037) was significantly greater than that for both modes of visual interpretation. CONCLUSIONS: 3D-SSP enhanced performance of the nuclear medicine physicians inspecting SPECT. Performance of the automated diagnosis exceeded that of the physicians inspecting SPECT with and without 3D-SSP.     

Present situation of home care and roles of nurses at Tokyo Women's Medical University Hospital--through the 5-year home care support activities

Diseases, details of interventions, medical cares provided and the condition of use and services of local medical institutions were investigated in the home care support activities during the period from November 1997 to March 2003. We intervened in 1,309 patients. 70% of them were terminal patients with malignant tumor. Interventions were mostly consultations about the life under medical care, guidance about HPN/tube feeding, consultations about nursing and coordination with local medical institutions. 422 of them were under care of family doctors. 502 of them used visiting nursing. 70% of the patients under care of the hospital required high-tech home care and home hospice care. The 5-year activities indicate that nurses who support home care at the hospitals providing acute medical care are expected to 1. serve as the consultation contact for patients and families, 2. support the life under medical care in consultation with internal and external related professionals, 3. use social resources, 4. serve as the contact for providing the logistic support under an emergent situation or under the lack of care-giving capabilities, 5. provide guidance for the safe use of high-tech home medical care by patients/families at the discharge, 6. communicate or coordinate with local medical institutions for continued care/nursing and 7. develop/support the flexible and convenient distribution system of medical equipment and medical materials/drugs or the 24-hour healthcare support system jointly with private enterprises.     

The relationship between shift work and the onset of hypertension in male Japanese workers

We assessed the effect of shift work on the onset of hypertension. The design of this study was that of a cohort study from 1991-2001. In sum, 5338 workers comprised this cohort. The event was the onset of hypertension (systolic blood pressure >or=140 mm Hg and/or diastolic blood pressure >or=90 mm Hg and/or medication). Pooled logistic regression analysis was performed, including job schedule type, age, body mass index, lifestyle, and the results of blood chemistries as covariates. The odds ratio of the onset of hypertension in shift workers for daytime workers was 1.10 and significant. Our study revealed that shift work independently affected the onset of hypertension, and suggested that shift work is a risk factor for the onset of hypertension.     

The association between dispensing error factors and behavioral characteristics of pharmacists

We evaluated error prevention education by clarifying the association between dispensing error factors and behavioral characteristics of pharmacists. The subjects were 98 pharmacists (27 men and 71 women) with a mean age of 29.7 years who gave informed consent for participation in our survey. Between November 2001 and January 2002, a questionnaire survey on dispensing errors was performed using the "Tokyo University Egogram, New Version" for the assessment of behavioral characteristics and the "Safety Behavior Questionnaire" for the assessment of error factors. An association was observed between the incidence of dispensing errors and behavioral characteristics. There was also an association between error contents and behavioral characteristics as well as error factors. With more experience, errors associated with becoming accustomed increased, suggesting that error prevention education is necessary not only for newly qualified pharmacists but also for managers.     

Serum soluble interleukin-2 receptor in eosinophilia

The relationship between soluble interleukin-2 receptor (sIL-2R) levels and clinical characteristics was evaluated in patients with eosinophilia. Thirty-eight out of 60 patients showed sIL-2R levels of more than 800 U/ml. In these patients, sIL-2R was closely related to the eosinophil count, but not the IgE level. Their underlying diseases were heterogeneous, including neoplasms and collagen diseases. In patients with lower sIL-2R levels, there was no relationship to the eosinophil count, but sIL-2R was correlated with the IgE level. These findings indicate that patients with eosinophilia and higher sIL-2R levels tend to have underlying diseases other than allergy, and might be more severely ill than patients with lower sIL-2R levels. sIL-2R may be a good marker for evaluating patients with eosinophilia, as an indicator of the probable etiology and severity of their diseases.     

Epidermal Growth Factor-dependent Dissociation of CrkII Proto-oncogene Product from the Epidermal Growth Factor Receptor in Human Glioma Cells

Human glioma cells frequently overexpress epidermal growth factor receptor (EGFR). We found that the CrkII proto-oncogene product was associated with the EGFR in human glioma cells in the absence of epidermal growth factor (EGF). EGF stimulation of glioma cells induced the phosphorylation of tyrosine 221 of the CrkII protein, which correlates with its dissociation from the EGFR. By contrast, Shc and Grb2 were inducibly associated with the EGFR in response to EGF stimulation of glioma cells. In A431 cells, epidermoid carcinoma cells which overexpress EGFR, CrkII was tyrosine-phosphorylated and associated with the EGFR in an EGF-dependent manner. Therefore, the dissociation of CrkII from the EGFR upon stimulation with EGF appears to be specific to glioma cells. The Cbl oncogene product was also tyrosine-phosphorylated in U87MG glioma cells upon EGF stimulation. However, unlike in other cell lines, CrkII was not inducibly bound to Cbl in U87MG glioma cells. Thus, EGF-dependent binding of CrkII to phosphotyrosine-containing proteins appears to be suppressed in glioma cells. To evaluate the physiological role of dissociation of CrkII from EGFR, we expressed the CrkII-23 mutant in glioma cells. CrkII-23 mutant, which was isolated as a suppressor gene of the EGF-dependent transformation of NRK cells, binds constitutively to EGFR. We found that expression of CrkII-23 inhibited the anchorage-independent growth of the glioma cells in the presence of EGF. Taken together, these data implicate EGF-dependent dissociation of CrkII from EGFR in the oncogenicity of human glioma cells.     

Quantitative evaluation of elderly skin based on digital image analysis

Background: The evaluation of the skin state when it is healthy at the time of examination, but predisposed to disease, is based solely on the subjective assessment of clinicians. This assessment may vary from moment to moment and from rater to rater. Purpose: We focused on skin texture and aimed to develop a new method to evaluate skin integrity of the elderly using a digital skin image, by verifying the reliability of the clinical evaluation of elderly skin image by specialists to create a ‘gold standard,’ and by analyzing a digital skin image to identify the indices that explain the skin condition as evaluated by specialists. Methods: A total of 208 skin images were collected from 34 subjects. And then we processed and analyzed images. Modified Kobayashi's method and texture analysis method were used in image analysis. Kobayashi's method included the process of density transformation, cross binarization, short straight line matching and extraction of main sulcus, and calculation of each index. Texture analysis was performed on cross‐binarized images for quantification of uniformity. On the other hand, skin textures in images were scored by six plastic surgeons, using a 10‐point Likert scale, where 1 represented ‘very bad regularity’ and 10 represented ‘very good regularity.’ The inter‐rater reliability was verified by means of the intraclass correlation coefficients (ICC). Finally, stepwise multiple regression analysis was used to extract useful indices; where the clinical evaluation of the physicians (gold standard) was considered to be a dependent variable, and indices obtained from digital skin image analysis to be independent variables. Results: The ICC of raters was 0.92 (95% confidence interval; 0.91–0.94) when including all raters, therefore the score of all raters was used. As a result of stepwise multiple regression, the index of interval (L), thickness (T_ave), energy 0°, and entropy 45° independently explained the clinician evaluation. R² in multiple regression equation was 0.59. Conclusions: It is shown that quantitative evaluation using skin images and their analysis is one method of determining skin integrity in the elderly. The indices to explain the clinical evaluation of specialists were defined and these indices were obtained simply by using a skin image.     

Aortic pressure augmentation as a marker of cardiovascular risk in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is associated with increases in cardiovascular morbidity and mortality. Vascular changes in individuals with OSAS have not been fully elucidated, however. The possible impact of OSAS on the extent of aortic pressure augmentation (AG), an indicator of cardiovascular risk, was investigated. Forty-five consecutive male patients aged 35 to 78 years (56.0+/-9.6 years) who were referred to the sleep clinic of Nagoya University Hospital for screening and treatment of OSAS and 71 age-matched healthy men were enrolled in the study. AG was derived from the pressure waveform measured at the radial artery by applanation tonometry. The number of apnea and hypopnea episodes per hour (apnea-hypopnea index [AHI]) was determined by standard polysomnography. AG was significantly greater in OSAS patients than in controls (9.0+/-4.1 vs. 6.4+/-3.4 mmHg, p<0.001), and it was significantly reduced in 19 OSAS patients treated with continuous positive airway pressure. AG was also significantly correlated with the AHI (r=0.562, p<0.001) and age (r=0.356, p=0.016) but not with the serum concentrations of low and high density lipoprotein-cholesterol, triglyceride, or glycosylated hemoglobin. Stepwise multiple regression analysis revealed that the AHI was the most significant contributing factor to the increased AG in OSAS patients (beta=0.109, r=0.530, p<0.001). OSAS may thus have an adverse effect on vascular function that can be ameliorated by appropriate treatment.