Head motion evaluation and correction for PET scans with 18F-FDG in the Japanese Alzheimer’s disease neuroimaging initiative (J-ADNI) multi-center study

Objective

Head motion during 30-min (six 5-min frames) brain PET scans starting 30 min post-injection of FDG was evaluated together with the effect of post hoc motion correction between frames in J-ADNI multicenter study carried out in 24 PET centers on a total of 172 subjects consisting of 81 normal subjects, 55 mild cognitive impairment (MCI) and 36 mild Alzheimer’s disease (AD) patients.

Methods

Based on the magnitude of the between-frame co-registration parameters, the scans were classified into six levels (A–F) of motion degree. The effect of motion and its correction was evaluated using between-frame variation of the regional FDG uptake values on ROIs placed over cerebral cortical areas.

Result

Although AD patients tended to present larger motion (motion level E or F in 22 % of the subjects) than MCI (3 %) and normal (4 %) subjects, unignorable motion was observed in a small number of subjects in the latter groups as well. The between-frame coefficient of variation (SD/mean) was 0.5 % in the frontal, 0.6 % in the parietal and 1.8 % in the posterior cingulate ROI for the scans of motion level 1. The respective values were 1.5, 1.4, and 3.6 % for the scans of motion level F, but reduced by the motion correction to 0.5, 0.4 and 0.8 %, respectively. The motion correction changed the ROI value for the posterior cingulate cortex by 11.6 % in the case of severest motion.

Conclusion

Substantial head motion occurs in a fraction of subjects in a multicenter setup which includes PET centers lacking sufficient experience in imaging demented patients. A simple frame-by-frame co-registration technique that can be applied to any PET camera model is effective in correcting for motion and improving quantitative capability.

     

Hyaluronan injection therapy for athletic patients with patellar tendinopathy

BackgroundPatellar tendinopathy produces activity-related pain and focal tenderness at the attachment of the patellar tendon at the lower pole of the patella. It frequently causes a reduction in athletic ability. An injection of hyaluronan was found to be useful for patellar tendinopathy, provided the indication is appropriate, based on the authors' pilot cases. The purpose of this study was to summarize the clinical experience of and to describe the appropriate indication for this injection therapy.MethodsFifty patients were treated from January 1999 to December 2006. The observation period averaged 25.7 months (range 6–88). All patients were graded stage 2 or 3 by Blazina's classification. Each treatment was counted separately for 9 patients (10 knees) who had more than one treatment period with 3 months or more between the injections. There were 4 bilaterally injected patients. Patellar tendinopathy was classified into 4 types according to the degree of tenderness and the regions that are tender. Hyaluronan was injected into the interface between the patellar tendon and the infrapatellar fat pad at the proximal insertion, or into the region of maximum tenderness.ResultsThe total number of injections was 135, and there were an average of 2.0 injections per case (range 1–11). Following treatment, 54 % of the cases were rated in excellent condition, as they were able to return to their previous athletic activities with little difficulty, while 40 % of the cases were rated in good condition—these patients were able to return to their previous sporting activities with some degree of limitation.ConclusionsHyaluronan injection therapy for athletic patients with patellar tendinopathy is an optional but effective treatment.     

Rating and issues of mechanical anastomotic staplers in surgical practice: a survey of 241 Japanese gastroenterological surgeons

Purpose

Commercially available mechanical devices for gastrointestinal anastomosis are mostly made in overseas. Japanese female surgeons have described these devices as being too large and difficult to handle. This study investigated the degree of satisfaction and problems experienced by Japanese surgeons in using various staplers for mechanical anastomosis.

Methods

A questionnaire was prepared and sent via email to 5,537 members of the Japanese Society of Gastroenterological Surgery. The questionnaire included sex, age, surgical glove size, degree of satisfaction with various mechanical staplers, stress felt when using the staplers in anastomosis, and problems regarding the devices.

Results

Valid responses were received from 241 respondents (167 males, 74 females, response rate 4.9 %). The satisfaction rate ranged from 0 to 100 %. The average glove size in males was significantly larger than that in females (median: 7.0 versus 6.0; P < 0.0001). Surgeons with glove size 6.0 or smaller felt stress more frequently than those with size 6.5 or larger (median: 40 vs. 20 %; P < 0.0001). Surgeons with glove size 6.0 and smaller experienced more difficulties during firing and releasing.

Conclusion

The satisfaction rates with currently available mechanical staplers were low. Japanese surgeons with small hands felt more stress when using the staplers. Ergonometric consideration is necessary in stapler design.     

Characteristic Immunophenotype of Solid Subtype Component in Lung Adenocarcinoma

Background

Lung adenocarcinomas represent a morphologically heterogeneous tumor composed of an admixture of different histologic subtypes (lepidic, papillary, acinar, and solid subtype). The presence of a solid subtype component is reported to be associated with a poorer prognosis. The aim of this study was to evaluate the characteristic immunophenotype of the solid subtype component compared with the immunophenotypes of other components.

Methods

We analyzed the clinicopathological characteristics of stage I adenocarcinoma patients with predominant solid subtype disease. Furthermore, we immunostained adenocarcinomas with predominant lepidic, papillary, acinar, and solid subtype components (n?=?23 each) for 10 molecular markers of tumor invasiveness and scored the results.

Results

Patients showing predominance of the solid subtype component (solid subtype adenocarcinoma) had a poorer prognosis than those showing predominance of the lepidic, papillary, or acinar component. Lymphovascular invasion was more often detected in solid subtype tumors than in others. The solid subtype component showed a significantly stronger staining intensity of laminin-5 expression than the lepidic, papillary, and acinar components (P?<?0.001, P?<?0.001, and P?=?0.016, respectively). The fibronectin and vimentin expression levels were also significantly higher in the solid subtype component than in other components. This immunostaining character was validated by using mixed-subtype adenocarcinomas containing all four components in the same tumor.

Conclusions

This study concluded that the solid subtype component in lung adenocarcinomas exhibit the invasive immunophenotype, including increased laminin-5 expression, compared with the other components, which may be associated with a poorer prognosis.     

Case of juxta-articular osteoid osteoma of calcaneus mimicking arthritis

Juxta-articular osteoid osteoma is a rare disorder that is difficult to correctly diagnose at an early stage. We report a case of osteoid osteoma in the calcaneus that arose near to the talocalcaneal joint. An 18-year-old female presented with symptoms of joint swelling and effusion similar to those of monoarthritis. Conservative treatment proved ineffective in achieving pain relief, and she underwent surgery 6 months later. The lesion was diagnosed by histologic examination, and it resolved after resection of the tumor.     

The relationship between the soluble Klotho protein and the residual renal function among peritoneal dialysis patients

Background

Klotho has been investigated as an anti-aging protein that is predominantly expressed in the distal convoluted tubules in the kidneys and in the choroid plexus of the brain. The purpose of the present study was to determine the relationship between the soluble form of Klotho and renal function in chronic peritoneal dialysis (PD) patients, a relationship which remains poorly understood.

Methods

The soluble Klotho levels in the serum, urine, and peritoneal dialysate obtained from thirty-six PD patients were determined by a sandwich enzyme-linked immunosorbent assay system.

Results

The amount of urinary excreted soluble Klotho over 24?h ranged from 1.54 to 1774.4?ng/day (median 303.2?ng/day; interquartile range [IR] 84.1–498.5), while the serum soluble Klotho concentration ranged from 194.4 to 990.4?pg/ml (mean 553.7?±?210.4?pg/ml). The amount of urinary Klotho excretion was significantly correlated with residual renal function. However, there was no apparent correlation between the serum soluble Klotho levels and the residual renal function. Klotho was also detected in the 24-h dialysate collections. There was a significant correlation between the peritoneal Klotho excretion and the amount of albumin contained in the dialysate collections (r?=?0.798, p?Conclusions The total amount of urinary excreted Klotho, but not the serum level of soluble Klotho, may be a potential biomarker for assessing the residual renal function among PD patients. Whether our findings are also valid for chronic kidney disease patients overall should therefore be evaluated in greater detail.     

Surgical techniques and therapeutic results of anatomical reconstruction of coracoclavicular ligaments for acromioclavicular joint dislocations

Backgrounds

Generally, the surgical treatment for traumatic acromioclavicular joint dislocation is recommended for type 5 according to Rockwood’s classification. We believe that anatomical restoration of coracoclavicular ligament could best restore the function of the acromioclavicular joint. We attempted to correctly reconstruct the anatomy of the coracoclavicular ligament (trapezoid and conoid ligaments) in which the ipsilateral palmaris longus tendon and Endobutton were used as the reconstructing ligament and fixation material, respectively.

Study designs

Cross-sectional study.

Methods

The subjects were 16 patients (15 men and one woman). The mean age at the time of the surgery was 38.6?years. The mean time of the surgery from the injury was 16.3?days. The mean duration of postoperative follow-up was one?year and 5?months.

Results

The reduction in the acromioclavicular joint was complete in 10 of 16 patients. Meanwhile, the subluxation that represented less than 5?mm superior translation of the clavicle, occurred only in 5, that represented 5–10?mm superior translation in none, and the complete dislocation occurred in one patient. Concerning the range of motion, mean forward flexion was 171°, mean abduction was 165°, mean internal rotation was Th11, and mean horizontal adduction was 132°. Pain, fatigues on the shoulder girdle, and impairments with shoulder motion on the affected side disappeared one?month after surgery.

Conclusion

Although it requires excision of the ipsilateral palmaris longus for graft, we believe that anatomical restoration of both coracoclavicular ligaments could best restore the function of the acromioclavicular joint.     

The time course of flow-mediated vasodilation and endothelial dysfunction in patients with a cardiovascular risk factor

The relationship between having a cardiovascular risk factor and endothelial dysfunction observed on a time-course analysis of brachial artery flow-mediated vasodilation (FMD) remains unclear. We enrolled 257 patients who had at least one cardiovascular risk factor. We measured FMD magnitude of the percentage change in peak diameter (ΔFMD), maximum FMD rate calculated as the maximum slope of dilation (FMD-MDR), and integrated FMD response calculated as the area under the dilation curve during the 60- and 120-second dilation periods (FMD-AUC₆₀ and FMD-AUC₁₂₀) using a semiautomatic edge-detection algorithm. FMD-AUC₆₀ and FMD-AUC₁₂₀ were negatively correlated with the Framingham risk score (FMD-AUC₆₀: r = ?0.15, P = .023; FMD-AUC₁₂₀: r = ?0.17, P = .007), whereas this association was not found in the case of either the ΔFMD or the FMR-MDR. The Framingham risk score was significantly higher in patients in the lowest tertile for FMD-AUC₁₂₀ (FMD-AUC₁₂₀ <5.0 mm × second) than in those in the highest tertile for FMD-AUC₁₂₀ (FMD-AUC₁₂₀ ≥11.0 mm × second) (12.9 ± 8.7 vs. 8.6 ± 7.8%, P = .002). The lowest tertile for FMD-AUC₁₂₀ was independently associated with the Framingham risk score (β = 0.10, P = .011), after adjustments were made for age, gender, and smoking and drinking status. FMD-AUC₁₂₀ was associated with cardiovascular risk.