Reliability of diagnosing acute ischemic cerebrovascular on magnetic resonance imaging disorders using iPads

Purpose

The use of tablet terminals has been explored in various medical settings; however, caution should be exercised when performing image diagnosis using this technology. The present study examined the characteristics of an iPad Air? monitor and assessed radiographic image interpretations to verify the reliability of the telediagnosis of acute cerebral infarction based on magnetic resonance imaging (MRI) using a tablet terminal.

Materials and methods

The luminance of the iPad Air? was measured using a UA-10 analyzer, and radiographic image interpretation experiments were performed in 100 patients who underwent MRI within 6 h of symptom onset. Ten physicians viewed the images on the iPad Air? and a medical monitor, with an interval of 2 months between each interpretation.

Results

When the iPad Air? screen was pure white, the contour lines revealed nonuniform luminance distribution. In the reading experiment, the areas under the curve of the medical monitor and the iPad Air? were 0.9311 and 0.9431, respectively. No significant difference was observed between the medical monitor and the iPad Air? (p?=?0.113).

Conclusion

The results of the observer performance studies for detecting acute ischemic cerebrovascular disorders on an iPad Air? were found to be similar to those on a medical monitor.

     

A sixty-year-old man suffering from multiple system atrophy with pneumatosis intestinalis]

We herein report a 60-year-old man demonstrating multiple system atrophy of the cerebellar type (MSA-C) with a five-year of clinical history, who developed severe constipation followed by watery diarrhea. An abdominal CT scan showed free air in the abdominal cavity and extensive pericolic gas accumulation in the ascending and transverse colon. He was diagnosed to have pneumatosis intestinalis (PI). The air in the abdominal cavity as well as in the wall of the colon thereafter disappeared after nine days' of conservative therapy. The presense of chronic idiopathic intestinal pseudo-obstruction due to severe dysautonomia and a longstanding bed-ridden state may have been the cause of PI in this patient. This is the first case report of PI associated with MSA; however, the association of PI may have been overlooked in this disorder because of severe constipation and diarrhea, the two cardinal symptoms of PI, which happen to also be two of the typical symptoms of MSA itself.     

Testicular cytochrome P450scc and LHR as possible targets of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in the mouse

Exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in adult animals has been reported to perturb the regulation of steroidogenesis in the testis, possibly by arylhydrocarbon receptor (AhR). To clarify how AhR is involved in the testicular steroidogenesis, we carried out comparative experiments using wild-type and AhR-null male mice that were intraperitoneally administered TCDD. The TCDD administration to wild-type mice showed significant reduction of P450scc and LHR in the testis, whereas the levels in the AhR-null mouse testis were unchanged. To compare anti-androgenic properties on hypothalamo-pituitary-gonadal (HPG) axis, estradiol-3-benzoate (EB), a synthetic estrogen agonist, was administered to mice, the expression of the LHalpha/FSHalpha, LHbeta, FSHbeta and GnRHR genes was severely impaired in the pituitary gland, in contrast to no observed effects in the TCDD-treated mice. In addition, the expression of the LHR gene was increased in the testis of the EB-treated mice. These observations suggest that the target of TCDD is different from that of EB on HPG axis and that TCDD treatment suppresses the P450scc and LHR genes in the testis in an AhR-dependent manner.     

Is systemic node dissection for accuracy staging in clinical stage I non-small cell lung cancer worthwhile in the elderly?

OBJECTIVE: The therapeutic role of systematic node dissection (SND) for early lung cancer remains controversial. Elderly patients have a background of insufficient physiological function and comorbidity, and a shorter life expectancy than that of younger patients. Therefore, we have evaluated the impact on survival, local recurrence, and complications of not performing systematic lymph node dissection in the elderly. METHODS: A retrospective analysis of 126 patients, including the elderly (75 - 89 years), who underwent a lobectomy for clinical stage I was performed. The patients were grouped according to node dissection numbers after surgery, and finally separated into two groups (SG: sufficient group, dissections of more than 10 nodes and 3 or more mediastinal stations; IG: insufficient group, less than 10 nodes and one or two mediastinal stations). Postoperative morbidity and sites of recurrence were evaluated between the two groups, and the survival rates were analyzed at 5 years. RESULTS: Upstage was identified in 12.6% of patients: 7.3% in IG (n = 45), 15.2% in SG (n = 86). Postoperative mortality occurred in 2 cases (1.58%). The incidence of postoperative respiratory or cardiac complications was more frequent in the SG, while there were fewer complications in the IG. There was no significant difference in recurrence rates between the two groups. Both local and distant recurrence was observed in the two groups. The 5-year survival rates were 61.5% for the SG and 59.4% for the IG. There was no significant difference in the survival rate between the IG and SG patients. CONCLUSIONS: Proper staging and the avoidance of nontherapeutic lymph node dissection seems acceptable for clinical stage I lung cancer in the group of elderly patients.     

Nasal Continuous Positive Airway Pressure Improves Quality of Life in Obesity Hypoventilation Syndrome

We studied the quality of life of obesity hypoventilation syndrome (OHS) by comparing it with age- and body mass index-matched patients without hypoventilation and age-matched obstructive sleep apnea (OSA) patients with body mass index (BMI) under 30, and the efficacy of nasal continuous positive airway pressure (CPAP) therapy for 3 to 6 months on the quality of life in these patients. Prospectively recruited patients from six sleep laboratories in Japan were administered assessments of the general health status by the Short-Form 36 Health Survey (SF-36) and subjective sleepiness by the Epworth Sleepiness Scale (ESS). Compared with matched healthy subjects, OHS and OSA patients not yet treated had worse results on the ESS scores and the SF-36 subscales for physical functioning, role limitations due to physical problems, general health perception, energy/vitality, role limitations due to emotional problems, and social functioning. The ESS scores of OHS patients were worse than those of the OSA groups including the age- and BMI-matched OSA patients. In the SF-36 subscales of OHS patients, only the subscale of social functioning showed worse results compared with that of BMI-matched OSA patients. After 3 to 6 months of treatment, ESS scores and these SF-36 subscales in all three patient groups improved to the normal level. These results suggested that the quality of life of OHS before nasal CPAP was significantly impaired and that nasal CPAP for OHS improved the quality of life associated with the improvement of daytime sleepiness to the level of the other OSA patients.     

Morphogenesis of phi X174: in vitro synthesis of infectious phage from purified viral components.

An in vitro system that synthesizes infectious phage phi X174 was developed. The synthesis depended on phi X174 supercoiled replicative form DNA, purified phi X174 gene A protein, gene C protein, gene J protein, prohead (phage head precursor composed of gene F, G, H, B, and D proteins), and uninfected host crude extract. The infectious phage synthesis was coupled with DNA synthesis. De novo initiation, elongation, and termination of phi X174 single-stranded DNA was observed. The phage synthesized in vitro cosedimented with in vivo phage in sucrose gradients and had the same buoyant density as in vivo phage in a CsCl gradient. Our results indicate that the in vitro system mimics the in vivo phi X174 assembly process.     

The prognostic value of positron emission tomography/computed tomography in rheumatoid arthritis patients with methotrexate-associated lymphoproliferative disorders

Recently, methotrexate-associated lymphoproliferative disorders (MTX-LPDs) in rheumatoid arthritis (RA) have been found to commonly occur in association with iatrogenic immunodeficiency. Several factors have been reported to be related to the prognosis. We herein investigate the efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in predicting the prognosis of MTX-LPD. We performed a retrospective analysis of the clinical features, characteristics, and outcomes of 18 patients with MTX-LPDs who were treated from 2004 to 2015. All of the patients were diagnosed with MTX-LPD based on the histological examination of biopsy specimens. Spontaneous regression was detected after the cessation of MTX in 5 of 18 cases (28%). The maximum standardized uptake value (SUVmax) of the FDG uptake on PET/CT was significantly lower, and the maximum size of the LPD-associated tumor was significantly smaller among the patients who showed spontaneous regression (p?=?0.01, p?=?0.04, respectively). Both the SUVmax and the maximum tumor size were related to better overall survival (p?=?0.02, p?=?0.04, respectively). Thus, PET/CT can be used to predict spontaneous regression and the prognosis at the diagnosis of MTX/LPD. Cases that showed spontaneous regression never relapsed during the follow-up period, despite the usage of several anti-rheumatoid arthritis drugs, including biological agents. The early detection of LPDs and the early cessation of MTX are important for the management of RA patients. An evaluation by F-FDG-PET/CT can be useful for predicting spontaneous regression and the prognosis.     

Simple Four-Variable Screening Tool for Identification of Patients with Sleep-Disordered Breathing

Objective:

To aid in the identification of patients with moderate-to-severe sleep-disordered breathing (SDB), we developed and validated a simple screening tool applicable to both clinical and community settings.

Methods:

Logistic regression analysis was used to develop an integer-based risk scoring system. The participants in this derivation study included 132 patients visiting one of 2 hospitals in Japan, and 175 residents of a rural town. The participants in the present validation study included 308 employees of a company in Japan who were undergoing a health check.

Results:

The screening tool consisted of only 4 variables: sex, blood pressure level, body mass index, and self-reported snoring. This tool (screening score) gave an area under the receiver operating characteristic curve (ROC) of 0.90, sensitivity of 0.93, and specificity of 0.66, using a cutoff point of 11. Predicted and observed prevalence proportions in the validation dataset were in close agreement across the entire spectrum of risk scores. In the validation dataset, the area under the ROC for moderate-to-severe SDB and severe SDB were 0.78 and 0.85, respectively. The diagnostic performance of this tool did not significantly differ from that of previous, more complex tools.

Conclusion:

These findings suggest that our screening scoring system is a valid tool for the identification and assessment of moderate-to-severe SDB. With knowledge of only 4 easily ascertainable variables, which are routinely checked during daily clinical practice or mass health screening, moderate-to-severe SDB can be easily detected in clinical and public health settings.

Citation:

Takegami M; Hayashino Y; Chin K; Sokejima S; Kadotani H; Akashiba T; Kimura H; Ohi M; Fukuhara S. Simple four-variable screening tool for identification of patients with sleep-disordered breathing. SLEEP 2009;32(7):939-948.     

Immunological equivalence between mouse brain-derived and Vero cell-derived Japanese encephalitis vaccines

The persistent spread via animal reservoirs urges expanding vaccination programs against pathogens like the Japanese encephalitis virus, JEV. The JEV is spreads to new areas by domestic as well as by wild animals. Although there is a safe and efficient vaccine on the market, this is derived from infected mouse brains, why today's situation requires overcoming the potential risk caused by using animal tissues. To meet this demand we have developed a Vero cell-derived JEV vaccine, using the same virus strain as in the established one. A phase III clinical study of the new vaccine has recently been completed with positive outcome. Like the established mouse brain-derived vaccine, the Vero cell-derived one is a formalin inactivated whole virus vaccine. We here demonstrate the very good agreement in immunological tests between the two antigens. The study includes analyses with two neutralizing monoclonal antibodies that blocks cell entry at a late stage in infection, assumedly interfering with fusion-related refolding in the virus fusion protein. It is obvious that the formalin inactivation treatment, with both virus preparations, retains these essential vaccine epitopes.