Novel contrast-injection protocol for high-resolution abdominal CT-angiography: vascular visualization improvement with vasodilator

Purpose

To evaluate the usefulness of a novel contrast-injection protocol for high-resolution abdominal computed tomography angiography (CTA) using nitroglycerin (NTG).

Methods

Abdominal CTA was performed in 80 patients using two 64-detector-row CT scanners. Forty patients were examined after administration of sublingual NTG (NTG group), while 40 were examined without NTG administration (non-NTG group). Arterial phase images were acquired with maximum intensity projection and volume rendering. Reduction rates: vessel cross-sectional areas ratio of 10 cm distal to origin at the superior mesenteric artery, contrast enhancements, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were assessed. Three reviewers evaluated degree of depiction of the peripancreatic vasculature using a four-point scale (1 = poor, 4 = excellent).

Results

Reduction rates were significantly lower in the NTG group (P < 0.001), while there were no significant differences in contrast enhancements, SNR, or CNR between groups. Visual evaluation results of the NTG group were significantly better than those of the non-NTG group (P < 0.01).

Conclusion

Abdominal CTA using NTG improved visualization of the abdominal peripheral vessels. This improved arterial view may be beneficial for preoperative evaluation of the arterial anatomy.

     

Human leukocyte antigens in Japanese patients with biliary atresia: retrospective analysis of patients who underwent living donor liver transplantation

Biliary atresia (BA) is a neonatal obstructive cholangiopathy characterized by a fibrosclerosing obliteration of the extrahepatic bile duct. The aim of this study was to investigate the relationship between human leukocyte antigens (HLA) and susceptibility to BA. We retrospectively analyzed 392 Japanese patients with BA and without extrahepatic anomalies who underwent living donor liver transplantations at our institute. Healthy Japanese volunteers (n = 828) served as normal controls. A significant positive association was observed between BA and HLA-DR2 (39.0% of patients vs. 30.4% of controls, odds ratio = 1.46, p = 0.029). Two-locus analyses disclosed that DR2 was not independently associated with BA, but the increased frequency of HLA-A24 and -B52 reflected the linkage disequilibrium between -A24, -B52, and -DR2. Moreover, the frequency of the haplotype HLA-A24-B52-DR2 was significantly higher in patients with BA than in the general Japanese populations described in the literature (odds ratio = 2.20, p = 0.00124). These results indicate that the gene for BA susceptibility is in close linkage disequilibrium with the HLA-A24-B52-DR2 haplotype observed in the Japanese population. We speculate that a gene at the locus close to HLA plays an important role in the pathogenesis of BA.     

Development of a Japanese Version of the Care Planning Assessment Tool

Aim: To develop a Japanese version of the Care Planning Assessment Tool (J‐CPAT), originally developed in Australia as a comprehensive assessment of people with dementia. Methods: The process of adapting the CPAT into Japanese included translation into Japanese, assessment of item comprehension, and a validity and reliability study. The J‐CPAT is composed of eight domains: Communication, physical problems, self‐help skills, confusion, behaviour, social interaction, psychiatric observations and carer dependency. The participants were 199 aged care clients. Measures were the J‐CPAT, Mini‐Mental State Examination (MMSE) and Care Levels used in the Long‐term Care Insurance scheme. Results: Cronbach's alpha values in each J‐CPAT domain were 0.74–0.95. The correlation coefficient between the score of Confusion and MMSE was ?0.90, and those between physical problems, self‐help skills, carer dependency in the J‐CPAT, and care level were 0.70, 0.75 and 0.67. Conclusions: The J‐CPAT appears to be a reliable and valid tool for care planning in Japan.     

Development of the Japanese version Care Planning Assessment Tool (J-CPAT): reliability and validity studies

AIM: To develop a Japanese version Care Planning Assessment Tool (CPAT) , a comprehensive geriatric assessment instrument for dementia care, originally developed in Australia. METHODS: The J-CPAT is composed of 61 items, and 8 domains: Communication, Physical problems, Self-help skills, Confusion, Behavior, Social interaction, Psychiatric observation, and Care dependency. The development of the J-CPAT included translation into Japanese, assessment of item comprehension, back translation, production of final version, and its validity and reliability analysis. Through this process, an item about family interaction was added in the J-CPAT. The participants were 199 clients in residential and day care. Raters were professional carers with 2.5 hours training about the J-CPAT. We assessed the validity of the J-CPAT, using correlation between the scores of the J-CPAT, MMSE, NM-scale, N-ADL, and levels of care needs (Kaigodo). Ten pairs of carers were included in the inter-rater reliability analysis. Fourteen carers participated in the intrarater reliability study. RESULTS: Cronbach's alpha values in each J-CPAT domain were 0.74-0.95. Mean difference of each domain between test and retest was 0.4-3.6%. Weighted kappa values for all items for 10 pairs of raters were over 0.6. The correlation coefficients between the domain score of 'Confusion' in the J-CPAT and MMSE was -0.90 (p<0.01). Those between the domain scores of 'Physical problems', 'Self-help skills', 'Dependency on care' in the J-CPAT, and Kaigodo were sufficient (>0.62), and those between the item scores of the J-CPAT, NM-scale, and N-ADL were relevant (>0.60). CONCLUSIONS: The J-CPAT is considered to be an appropriate assessment instrument for dementia care in Japan.     

Cystoid macular edema in polypoidal choroidal vasculopathy viewed by a scanning laser ophthalmoscope

Visual prognosis for polypoidal choroidal vasculopathy (PCV) is reported to be relatively good. However, some eyes in the end-stage of PCV show cystoid macular edema (CME) with severe loss of vision. We examined two eyes with CME in the end-stage of PCV. The fundus of each of these eyes was examined noninvasively with a new commercially available scanning laser ophthalmoscope (SLO) in the retro-mode with an infrared laser. In the retro-mode, scattered light that passed the aperture deviated laterally, giving a shadow to the silhouetted cystoid spaces, enabled visualisation of the CME. In each eye, although no cystoid spaces were detected on fundus photographs, monochromatic images obtained with an SLO in the retro-mode showed numerous cystoid spaces on the disciform scar. SLO in the retro-mode can show each cystoid space located in any layer of the retina, and allows us to detect the extent of the CME.     

Adsorptive filtration systems for effective removal of blood amyloid β: a potential therapy for Alzheimer’s disease

Accumulation of amyloid-β protein (Aβ) in the brain causes cognitive impairment in Alzheimer’s disease. We hypothesized that an extracorporeal system that rapidly removed Aβ from the blood may accelerate Aβ drainage from the brain. We previously reported that dialyzers remove blood Aβs effectively, mainly by adsorption on the inner surfaces of the hollow fibers, resulting in lower Aβ accumulation in the brains of patients undergoing hemodialysis than the controls without hemodialysis. The aim of the present study was to create a more convenient and effective blood Aβ removal system using adsorptive filtration, in which the filtrate returned to the body. Filtration from inside to outside of the fibers may enhance the adsorption of plasma Aβs on the surface of micropores inside the hollow fiber walls. Hence, pool solutions of 4 ng/mL synthetic Aβ_1–40 and Aβ_1–42 peptides (300 mL) or human plasma (1000 mL of 250–346 pg/mL Aβ_1–40 and 30–48 pg/mL Aβ_1–42) were circulated through polysulfone dialyzers at a flow rate of 50 mL/min to evaluate an adsorptive filtration system. The rates of Aβ reduction from the pool solutions significantly increased along with the filtration rates. A filtration rate of >?1 mL/min, preferably 5–10 mL/min resulted in an 80–100% reduction of Aβs within 30 min of circulation. The rates of Aβs passing through the membrane walls were maintained around 0% for plasma Aβs during circulation. Thus, our adsorptive filtration systems may be useful for removing blood Aβs for patients with Alzheimer’s disease.     

Phenylketonuria in a six year old Malay boy--a case report

A six year old Malay boy with phenylketonuria is presented. The history, clinical examination, biochemical findings and treatment are described followed by a discussion on phenylketonuria.     

Visualization of cystoid macular oedema using a scanning laser ophthalmoscope in the retro‐mode

Purpose: To investigate cystoid macular oedema using a scanning laser ophthalmoscope. Methods: We retrospectively reviewed the medical records of 101 eyes with cystoid macular oedema because of various aetiologies. All eyes were examined with a new, commercially available scanning laser ophthalmoscope in the retro‐mode with an infrared laser. Results: In all eyes, scanning laser ophthalmoscope in the retro‐mode showed numerous oval or polygonal cystoid spaces. Most eyes showed a large cystoid space beneath the fovea, with surrounding small cystoid spaces. The area of the foveal cystoid space showed a correlation with its height, as measured with optical coherence tomography (R = 0.60, P < 0.0001). Visual acuity, however, did not show any correlation with either the area of the foveal cystoid space or area of all of the cystoid spaces in the macular area. Conclusion: Scanning laser ophthalmoscope in the retro‐mode can show each cystoid space located in any layer of the retina and allows us to detect the extent of cystoid macular oedema.