Diagnostic performance of a computer-assisted diagnostic system: sensitivity of BONENAVI for bone scintigraphy in patients with disseminated skeletal metastasis is not so high

Bone scintigraphy (BS) of disseminated skeletal metastasis is sometimes misinterpreted as normal. The use of computer-assisted diagnosis (CAD) may resolve this problem. We investigated the performance of a CAD system, BONENAVI, in the diagnosis of disseminated skeletal metastasis. Cases of disseminated skeletal metastasis were selected from a BS log. These patients’ BSs were analyzed by BONENAVI to obtain an artificial neural network (ANN) and bone scan index (BSI). Clinical features (type of primary cancer, CT type, and BS type) were compared with the BONENAVI (ANN and BSI) results. The BS findings (diffuse increased axial skeleton uptake, inhomogeneity of uptake, proximal extremity contrast, and degree of renal uptake) and ANN or BSI were evaluated. Then, negative ANN patients were presented. Fifty-four patients were diagnosed as having disseminated skeletal metastasis. Regarding the primary cancers, 12 had prostate cancer, 16 gastric cancers, 16 breast cancers, and 10 miscellaneous cancers. Total sensitivity of ANN (≥ 0.5) was 76% (41/54). ANN values correlated with the BS type among clinical features. Diffuse increased axial skeleton uptake was mostly correlated with ANN of the BS findings. The BONENAVI CAD system was partially helpful in diagnosing disseminated skeletal metastasis, but the sensitivity of BONENAVI was not sufficient and underestimated the disseminated skeletal metastasis. Further improvement of this CAD system is necessary to improve the detectability of disseminated skeletal metastasis.     

Gelation and luminescence of lanthanide hydrogels formed with deuterium oxide

Gel formations and efficient lanthanide luminescence appeared in deuterium oxide (D₂O) medium instead of light water (H₂O), and their solvation possibilities by using luminescence lifetimes were discussed. The lanthanide ions in the hydrogel of 1 obtained by H₂O (abbreviated as H₂O-Ln1; Ln = Eu, Tb, and Gd) in our previous report act as the coupling part between neighbor molecules for the bundle structure. Here, D₂O also acts as a medium to form the lanthanide-hydrogel of 1, and increases intensities of luminescence for Tb, because a soft crystalline state reducing resonance thermal relaxation is realized. The gel-formation and luminescence band positions of Ln1 in D₂O corresponded to those in H₂O. From the observation of luminescence lifetimes in H₂O and D₂O, the number of coordinating water molecules on Eu and Tb were estimated to be around 3 or 4 for both. The luminescence intensity of Eu1 did not increase even in D₂O, due to a blue shift of the excited triplet state of 1, as compared to that in H₂O.

Luminescent lanthanide hydrogels using the low-molecular weight gelator 1 in D₂O were developed and evaluated quantitatively.     

src homology 2 domain-containing tyrosine phosphatase SHP-1 controls the development of allergic airway inflammation

Th2 cells are generated from naive CD4 T cells upon T cell receptor (TCR) recognition of antigen and IL-4 stimulation and play crucial roles in humoral immunity against infectious microorganisms and the pathogenesis of allergic and autoimmune diseases. A tyrosine phosphatase, SHP-1, that contains src homology 2 (SH2) domains is recognized as a negative regulator for various intracellular signaling molecules, including those downstream of the TCR and the IL-4 receptor. Here we assessed the role of SHP-1 in Th1/Th2 cell differentiation and in the development of Th2-dependent allergic airway inflammation by using a natural SHP-1 mutant, the motheaten mouse. CD4 T cells appear to develop normally in the heterozygous motheaten (me/+) thymus even though they express decreased amounts of SHP-1 (about one-third the level of wild-type thymus). The me/+ naive splenic CD4 T cells showed enhanced activation by IL-4 receptor-mediated signaling but only marginal enhancement of TCR-mediated signaling. Interestingly, the generation of Th2 cells was increased and specific cytokine production of mast cells was enhanced in me/+ mice. In an OVA-induced allergic airway inflammation model, eosinophilic inflammation, mucus hyperproduction, and airway hyperresponsiveness were enhanced in me/+ mice. Thus, SHP-1 may have a role as a negative regulator in the development of allergic responses, such as allergic asthma.     

Onset age is associated with outcome of radioiodine therapy in Graves' disease

Controversy remains regarding the optimal dose calculation with radioiodine therapy for patients with Graves' disease. Here, we focused our analysis on data concerning the patient's pretreatment background, an empirically set dose of radioiodine and the post-treatment thyroid function, and investigated those factors that affected the outcome. The subjects consisted of 38 patients diagnosed as having Graves' disease. All patients were hospitalized to undertake radioiodine therapy between 1989 and 1998 at our hospital. At the follow-up periods of 6-, 12-, and 36-months after therapy, we divided the patients into two groups: one group those who had hypothyroid function, and the other those who had normal or hyperthyroid function. At 6- and 12-months, 50% of the patients belonged to the hypothyroid function group, whereas at 36-months, 55% of them had hypothyroid function. Logistic regression analysis, with the objective variable being the post-treatment hypothyroidism after 12 months, revealed that the significant factor was the onset age. We suggested that the age at onset should be considered in patients with Graves' disease to determine the optional radioiodine dose for the therapy.     

Legionella pneumonia due to exposure to 24-hour bath water contaminated by Legionella pneumophila serogroup-5

A 79-year-old man was admitted to hospital from his nursing home for treatment of pneumonia, but died 7 days after admission. Legionella pneumonia was diagnosed after isolation of Legionella pneumophila serogroup-5 from sputum culture. The environment of the nursing home was investigated; only water specimens from the 24-hour bath were positive by culture for Legionella pneumophila serogroup-5. Subsequent analysis by pulsed-field gel electrophoresis revealed an identical pattern in isolates from both sputum culture and 24 hour bath water culture. Among 123 inpatients and staff of the nursing home, 17 were found to be seropositive for Legionella pneumophila serogroup-5.     

Pharmacological intervention for renal protection during cardiopulmonary bypass

Summary The possibility of minimizing organ damage following cardiopulmonary bypass (CPB) was examined. In the control group,n = 21, upon completion of CPB, elevation of the lysosomal enzyme -glucuronidase, which is a sensitive indicator of cellular damage, was affected by the concentration of granulocyte elastase (r = 0.59) or the endothelial-derived constricting factor, endothelin, (r = 0.8). Renal damage, which was detected by an increase in renal tubular enzymes (N-acetyl--D-glucosaminidase and -glutamyltranspeptidase) in urine, was also affected by endothelin (r = 0.79, r = 0.56), elastase (r = 0.6, r = 0.71), and by free hemoglobin levels (r = 0.76, r = 0.82). Next, the efficacy of pharmacological intervention for the prevention of renal damage was evaluated. During CPB, the administration of an elastase inhibitor (ulinastatin, 3 × 10⁵IU),n = 8, or a calcium antagonist (nicaldipine HCl, elastase release inhibitor; 5 /kg per min),n = 8, significantly reduced the elevation of -glucuronidase and renal tubular enzymes (p < 0.05). Although the ulinastatin and nicardipine groups demonstrated low values of elastase in the Intensive Care Unit (ICU), only the values of the nicardipine group reached statistical significance (p < 0.05). A reduction in endothelin levels compared to the control group was observed in the nicardipine group. However, preventive and counteractive effects of nicardipine against vasoconstriction caused by endothelin were also considered to play an important role in the prevention of renal damage. The addition of haptoglobin (4,000 IU) to the priming solution of the CPB also reduced levels of renal tubular enzymes (p < 0.05). We concluded that elastase, endothelin, and free hemoglobin were causes of renal damage during CPB. The administration of ulinastatin, nicardipine, or haptoglobin possibly prevent apparent renal dysfunction after CPB.     

Neointimal proliferation around malapposed struts of a sirolimus-eluting stent: optical coherence tomography findings

A 65-year-old man with hypercholesterolaemia and hypertensionunderwent elective percutaneous coronary intervention (PCI)because of exertional angina. Three sirolimus-eluting stents(Cypher; 3.0     

A modified Japan Integrated Stage score for prognostic assessment in patients with hepatocellular carcinoma

Background For patients with hepatocellular carcinoma (HCC), the selection of effective therapeutic options depends on a reliable prognostic assessment of both the tumor characteristics and liver impairment. This study sought to provide a modified Japan Integrated Stage (m-JIS) score to predict more accurately the survival of patients with HCC. Methods We analyzed the records of 42 269 patients diagnosed with HCC that were registered between 1992 and 1999 in a nationwide Japanese database. The m-JIS score was calculated from the tumor-node-metastasis stage and the grade of liver damage as defined by the Liver Cancer Study Group of Japan. The predictive accuracy for patient survival based on the m-JIS score was compared with that determined by the modified Cancer of the Liver Italian Program (m-CLIP) score using the cross-validation method. Results Patients were divided randomly into two groups, a training sample for construction of prediction models (n = 21 127 patients with 8458 deaths) and a validation sample for assessment of those prediction models (n = 21 142 patients with 8434 deaths). Both the m-JIS score and the m-CLIP score showed good discriminatory ability in the training sample. In the validation sample, the residuals of prediction based on the m-JIS score were smaller than those of the m-CLIP score (P < 0.0001). Conclusions The m-JIS scoring system had better predictive accuracy than the m-CLIP score system for survival of Japanese patients with HCC.