Absorbed and effective doses from cone beam volumetric imaging for implant planning

OBJECTIVES

Volumetric CT using a cone beam has been developed by several manufacturers for dentomaxillofacial imaging. The purpose of this study was to measure doses for implant planning with cone beam volumetric imaging (CBVI) in comparison with conventional multidetector CT (MDCT).

METHODS

The two CBVI systems used were a 3D Accuitomo (J. Morita), including an image-intensifier type (II) and a flat-panel type (FPD), and a CB MercuRay (Hitachi). The 3D Accuitomo operated at 80 kV, 5 mA and 18 s. The CB MercuRay operated at 120 kV, 15 mA, 9.8 s. The MDCT used was a HiSpeed QX/i (GE), operated at 120 kV, 100 mA and 0.7 s, and its scan length was 77 mm for both jaws. Measurement of the absorbed tissue and organ doses was performed with an Alderson phantom, embedding the radiophotoluminescence glass dosemeter into the organs/tissues. The values obtained were converted into the absorbed dose. The effective dose as defined by the International Commission on Radiological Protection was then calculated.

RESULTS

The absorbed doses of the 3D Accuitomo of the organs in the primary beam ranged from 1-5 mGy, and were several to ten times lower than other doses. The effective dose of the 3D Accuitomo ranged from 18 muSv to 66 muSv, and was an order of magnitude smaller than the others. In conclusion, these results show that the dose in the 3D Accuitomo is lower than the CB MercuRay and much less than MDCT.

The common mechanisms of anterior cruciate ligament injuries in judo: a retrospective analysis

BACKGROUND

Although high prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported, there has been very little research concerning events preceding the injury.

OBJECTIVE

To determine the common situations and mechanisms of ACL injury in judo.

METHODS

A total of 43 cases of ACL injuries that had occurred during judo competition or practice were investigated, using questionnaires with interviews conducted by a single certified athletic trainer who has 20 years of judo experience to obtain information regarding the situation and mechanism in which the ACL injury occurred.

RESULTS

The number of ACL injuries when the participant's grip style was different from the style of the opponent (ie, kenka-yotsu style) (28 cases) was significantly greater than when the participant's grip style was the same as that of the opponent (ie, ai-yotsu style) (15 cases; p<0.001). The number of ACL injuries was significantly higher when the participant was attacked by the opponent than when counterattacked or when attempting the attack (p<0.001). In addition, being attacked with osoto-gari was revealed as the leading cause of ACL injury incidence among the participants (16.8%).

CONCLUSIONS

Grip style may be associated with ACL injury occurrence in judo. In addition, direct contact due to the opponent's attack may be a common mechanism for ACL injuries in judo.

Surface dose measurement in patients and physicians and effective dose estimation in patients during uterine artery embolisation

Surface dose monitoring in patients and physicians during 29 uterine artery embolisation (UAE) procedures was performed using photoluminescence dosemeters and thermo-luminescence dosemeters. Organ or tissue doses were measured with an anthropomorphic phantom using UAE exposure conditions averaged from the 29 cases, and effective doses were estimated for the patient. Entrance surface dose of the patients at the maximum dose position ranged from 121.5 to 1650 mGy. Estimated doses ranged from 3.16 to 43 mGy for the ovary and from 3.8 to 51.8 mGy for the uterus. The effective dose was 1.09-14.8 mSv. Monitored doses on the body surface of physicians were relatively high in the upper arm (5.41+/-1.52 to 163+/-17.25 microGy) and the hand and fingers (0.85+/-1.18 to 222+/-16.4 microGy).

Effects of music during exercise on RPE, heart rate and the autonomic nervous system

AIM

The purpose of this study was to investigate the relationship between the influence of music on RPE during sub-maximal exercise and on the autonomic nervous system before and after sub-maximal exercise.

METHODS

Heart rate (HR), HR variability (HRV) and rates of physical fatigue (RPE) during exercise at 60% and at 40% VO2max with and without music were measured. The exercise protocol consisted of a 30-min seated rest (control) period followed by a 30-min submaximal cycling exercise and a 35-min recovery period. Autonomic-nervous activity was measured before and after exercise. During exercise, RPE was recorded every 3 min and HR was recorded for every minute.

RESULTS

Although RPE did not differ during exercise at 60% VO2max, this value was lower during exercise at 40% VO2max in the presence, than in the absence of a favorite piece music (P < 0.05). HR, HFA and LFA/HFA of HRV significantly differed with exercise intensity in the absence (P < 0.05), but not in the presence of music.

CONCLUSIONS

These findings suggested that music evokes a ''distraction effect'' during low intensity exercise, but might not influence the autonomic nervous system. Therefore, when jogging or walking at comparatively low exercise intensity, listening to a favorite piece of music might decrease the influence of stress caused by fatigue, thus increasing the ''comfort'' level of performing the exercise.

Osseous abnormalities of the mandibular condyle: diagnostic reliability of cone beam computed tomography compared with helical computed tomography based on an autopsy material

OBJECTIVES

We compared the diagnostic reliability of cone beam computed tomography (3DX) and helical computed tomography (helical CT) for the detection of osseous abnormalities of the mandibular condyle, using macroscopic observations as the gold standard.

METHODS

Twenty-one temporomandibular joint autopsy specimens underwent imaging with 3DX and helical CT. The specimens were macroscopically evaluated for cortical erosion or osteophytosis and sclerosis. The images were independently assessed for the same osseous abnormalities. Observations with the two imaging modalities were compared with the macroscopic observations using the McNemar test.

RESULTS

According to the macroscopic observations, 10 of the 21 mandibular condyles and one fossa showed osseous abnormalities. 3DX detected abnormalities in eight of these condyles and helical CT identified abnormalities in seven, giving a sensitivity of 0.80 for 3DX and 0.70 for helical CT. The specificity of the condyle assessment was 1.0 for both 3DX and helical CT and hence, the accuracy was 0.90 and 0.86, respectively. No significant differences were detected between the 3DX and helical CT for assessment of osseous abnormalities of the mandibular condyle (P=0.286).

CONCLUSIONS

The cone beam CT equipment 3DX is a dose-effective and a cost-effective alternative to helical CT for the diagnostic evaluation of osseous abnormalities of the mandibular condyle.

Evaluation of the usefulness of the limited cone-beam CT (3DX) in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint

OBJECTIVES

The purpose of this study was to evaluate the usefulness of the limited cone-beam X-ray CT (3DX) (Morita Co., Japan) in measuring the thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

Twenty-one TMJs removed at autopsy from 21 cadavers were investigated macroscopically using dissection and 3DX imaging. A Digimatic Outside Micrometer and a 3DX-image tool were used to measure the minimum thickness of the RGF. Multiple measurements were made to identify the thinnest area. Once the thinnest areas had been identified, three linear measurements were made and the average value was used for statistical analysis.

RESULTS

The average macroscopic examination measurement was 1.37 mm (range 0.55-3.6 mm) and the average 3DX image measurement was 1.22 mm (range: 0.51-3.0 mm). There was no significant difference between these two groups using the Mann-Whitney U-test (P < 0.05). The Spearman's correlation coefficient by rank between these two groups was r = 0.93(P < 0.001).

CONCLUSION

These results suggest that bone thickness measurements of the RGF by 3DX imaging was effective.

Adiponectin, T-cadherin and tumour necrosis factor-alpha in damaged cardiomyocytes from autopsy specimens

This study determined the presence of adiponectin, T-cadherin (an adiponectin receptor) and tumour necrosis factor-alpha (TNF-alpha) in damaged myocytes from autopsied patients with acute or old myocardial infarction (MI) or dilated cardiomyopathy (DCM), using immunohistochemical staining. The enrolled patients included eight with acute MI, six with old MI and seven with DCM. Four autopsied individuals with no cardiac lesions were also enrolled as controls. Adiponectin and TNF-alpha were not observed in normal myocytes from control subjects, but T-cadherin was weakly detected. Immunoreactivity for adiponectin and T-cadherin was observed at the periphery of damaged myocytes from MI and DCM patients; intracellular reactivity for TNF-alpha was also seen. There were no statistically significant differences in the degree of reactivity for each molecule in the myocytes between the MI and DCM patients. These results suggest that the presence of adiponectin and TNF-alpha in damaged myocytes may contribute to the processes of myocardial injury occurring in MI and DCM.

Treatment of schizophrenia: implications derived from an intercultural hospital comparison between Germany and Japan

OBJECTIVES

The study was aimed at evaluating facets of psychiatric inpatient care of patients with schizophrenia in a German and a Japanese hospital.

METHODS

Based upon a sample of 865 inpatients of the Psychiatric State Hospital Regensburg (BKR) and 50 inpatients of the Tokyo Women's Medical University (TWMU) admitted in 1997, data of a psychiatric basic documentation system (BADO) were analysed with regard to essential process and outcome indicators.

RESULTS

Despite dissimilarities between both patient groups with respect to schizophrenic subtype, duration of illness as well as severity of illness and psychosocial functioning, the differences regarding therapeutic treatment and outcome were marked. In 1997, the rate of atypical neuroleptics was 18% at the BKR and 12% at the TWMU. Inpatients of the TWMU were given benzodiazepines and anticholinergic drugs significantly more frequently. Male patients of the TWMU showed more severe side-effects. Psychotherapy and sociotherapy were less frequently applied at the TWMU. Although the patient groups did not differ with regard to suicidal behaviour and overt aggressions during hospitalisation, we found a higher rate of mechanical restraints at the TWMU. In 1997, the average length of stay was significantly higher at the TWMU (153 days) than at the BKR (52 days), but inpatients of the TWMU improved only slightly better with regard to global psychosocial functioning (GAF) and severity of illness (CGI).

CONCLUSIONS

The revealed differences in treatment are likely due to differences in service provision and national practices in Germany and Japan and provide clues for quality improvements. The BADO is a useful tool for continuous quality management and an ongoing international exchange concerning psychiatric inpatient care.

Chlorogenate hydrolase-catalyzed synthesis of hydroxycinnamic acid ester derivatives by transesterification, substitution of bromine, and condensation reactions

A chlorogenate hydrolase (EC 3.1.1.42) synthesized 2-phenylethyl caffeate (2-CAPE) from 5-chlorogenic acid (5-CQA) and 2-phenylethyl alcohol (2-PA) (by transesterification), from 5-CQA and 2-phenylethyl bromide (2-PBr) (by substitution of bromine), and from caffeic acid (CA) and 2-PA or 2-PBr (by condensation) as well as hydrolysis of 5-CQA. Some reaction conditions including pH, temperature, substrate and solvent concentrates, and reaction time were optimized for the production of 2-CAPE. A maximal molar yield of 50% was achieved by transesterification, 4.7% by substitution of bromine, and 13% by condensation. Among the parameters studied for optimization, the pH of the buffer solution and concentration of 2-PA or 2-PBr affected the production of 2-CAPE. The optimum pH for the hydrolysis reaction was within the neutral range (pH 6.5), whereas the residual three reactions were only catalyzed within the acidic range (pH 3.0-4.0). The optimum concentrations of 2-PA and 2-PBr for three reactions were 5-70 vol% and no 2-CAPE was produced in the 2-PA or 2-PBr solutions containing powdered enzyme. The enzyme may bind to the caffeoyl moiety of 5-CQA or CA to form an enzyme-substrate complex. It then catalyzes four different reactions corresponding to the reaction conditions.

Inflammatory myoglandular colorectal polyps: a case series of nine patients

Inflammatory myoglandular polyp is an uncommon benign colorectal polyp. We treated nine cases of histologically verified inflammatory myoglandular polyp. The polyps were identified as a pedunculated protrusion located in the distal part of the large intestine. On colonoscopy, eight polyps had a smooth, spherical, and hyperemic surface, accompanied by a patchy mucous exudate. Magnification endoscopy revealed a rugged surface composed of smooth nodules. These colonoscopic findings corresponded to hyperplastic glands with occasional cystic dilation and inflamed stroma with proliferation of smooth-muscle fibers. Inflammatory myoglandular polyp appears to be a distinctive clinical entity, with a unique appearance on colonoscopy.

Occipital hypoperfusion in Parkinson's disease without dementia: correlation to impaired cortical visual processing

OBJECTIVE

The purpose of this study was to analyse changes in regional cerebral blood flow (rCBF) in Parkinson's disease (PD) without dementia.

METHODS

Twenty eight non-demented patients with PD and 17 age matched normal subjects underwent single photon emission computed tomography with N-isopropyl-p-[(123)I]iodoamphetamine to measure rCBF. The statistical parametric mapping 96 programme was used for statistical analysis.

RESULTS

The PD patients showed significantly reduced rCBF in the bilateral occipital and posterior parietal cortices (p<0.01, corrected for multiple comparison p<0.05), when compared with the control subjects. There was a strong positive correlation between the score of Raven's coloured progressive matrices (RCPM) and the rCBF in the right visual association area (p<0.01, corrected for multiple comparison p<0.05) among the PD patients.

CONCLUSIONS

This study showed occipital and posterior parietal hypoperfusion in PD patients without dementia. Furthermore, it was demonstrated that occipital hypoperfusion is likely to underlie impairment of visual cognition according to the RCPM test, which is not related to motor impairment.

A method for evaluating the entrance surface dose from the measurement of exposure and half value layer in intraoral radiography using a radiophotoluminescent dosemeter

A method for measuring entrance surface dose in intraoral radiography for nationwide survey for the determination of guidance levels was developed using a commercially available radiophotoluminescent dosemeter (RPLD) system. From the ratio of the readings of the RPLD detectors. with and without a 1 mm thick aluminium filter, half value layer (HVL) and the energy dependency correction factor were derived. HVL and exposure for intraoral radiography were obtained with uncertainties of +/- 0.11 mmAl (SD) and +/- 2.1% (CV), respectively. This has been achieved by calibration at various beam qualities used in intraoral radiography. The HVLs and outputs of intraoral radiography units were measured by means of the mailed RPLD holders and also by ionisation chambers in 19 dental schools in Japan. Results obtained from the two methods of measurement agreed well for both HVLs and outputs.

Dose measurement for patients and physicians using a glass dosemeter during endovascular treatment for brain disease

It has been reported that exposure of patients and physicians to radiation from interventional radiological procedures cannot be disregarded. Direct measurement of patient exposure used to be difficult due to possible interference by the detector with the observation of X ray images. Recently, a dosemeter system consisting of small-sized glass chips and a reader which adopts pulsed UV laser stimulation has been developed. Owing to its small size, radiolucency and physical characteristics, direct monitoring of surface dose has become feasible. Dose measurement for patients and physicians during neurointervention was done using the photoluminescence glass dosemeter system. The dose-response of the dosemeter was almost linear over a broad dose range, but its energy dependency was rather high without a filter, the use of which is recommended by the manufacturer to compensate for energy dependency. Variation of sensitivity of about 20% was observed for effective energies of 45-60 keV which are used in neurointervention. In spite of this shortcoming, the photoluminescence glass dosemeter system was judged to be a convenient means for monitoring dose during neurointervention.

Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer?

BACKGROUND AND STUDY AIMS

Endoscopic resection is increasingly being used in the treatment of early gastric cancer. The aim of the present study was to investigate the accuracy of pretherapeutic staging techniques for assessing the appropriateness of endoscopic resection.

PATIENTS AND METHODS

Both endoscopy and endosonography were carried out at our institution in the treatment of 234 early gastric cancers, with histological confirmation of malignancy following surgical resection (137 lesions) or endoscopic resection (97 lesions). The accuracy in detecting intramucosal cancer with each of the diagnostic procedures was assessed.

RESULTS

The accuracy rates for detecting intramucosal cancer using endoscopy and endosonography were calculated as 84 % (197 of 234) and 78 % (182 of 234), respectively. The accuracy tended to be lower in lesions located in the upper third of the stomach, in those measuring 2 cm or more in diameter, and in those with an undifferentiated histology with ulcer fibrosis. However, there were no significant differences in the accuracy rates between endoscopy and endosonography. Precise staging was achieved by endoscopy alone in 103 of 109 differentiated adenocarcinomas without ulcer fibrosis, where the lesions measured less than 2 cm in diameter.

CONCLUSIONS

Endoscopic resection is indicated in intramucosal gastric cancer lesions showing differentiated histology, no ulcer fibrosis and a diameter of less than 2 cm. EUS may additionally be used for further evaluation in these patients.

Endosonographic features of Brunner's gland hamartomas which were subsequently resected endoscopically

BACKGROUND AND STUDY AIMS

Brunner's gland hamartomas are uncommon duodenal submucosal tumors. We aim to describe their morphological characteristics, with particular attention to the endosonographic features.

PATIENTS AND METHODS

We reviewed the radiological, endoscopic, endosonographic, and histological findings from six Brunner's gland hamartomas which were completely removed by endoscopic resection.

RESULTS

The lesions appeared as broad-based, sessile, or pedunculated submucosal tumors, measuring 0.7 to 2 cm in maximal diameter. Three lesions contained tiny dimple-like depressions on the surface; in one lesion these were only recognized following the use of an endoscopic dye-spraying technique. All the lesions could be safely removed by endoscopic resection after endosonographic confirmation of the layer origin within the submucosa. The internal echo structure of the tumors appeared to be solid echogenic in two, simple cystic in two, and multicystic in the remaining two lesions. In three lesions with an indistinct boundary, some stromal proliferation and solid Brunner's glands were recognized in an area extending from the mucosa to the submucosa. These endosonographic features corresponded to histological findings comprising stromal proliferation and various degrees of solid and cystic glandular Brunner's glands.

CONCLUSIONS

Brunner's gland hamartoma is characterized endosonographically by a heterogeneous solid and/or cystic mass within the submucosa.

Control of ceramide-induced apoptosis by IGF-1: involvement of PI-3 kinase, caspase-3 and catalase

Insulin-like growth factor-1 (IGF-1) inhibited N-acetylsphingosine (C2-ceramide)-induced HL-60 cell apoptosis via relieving oxidative damage. This inhibitory action of IGF-1 was blocked by a phosphatidylinositol-3 (PI-3) kinase inhibitor wortmannin and enhanced by overexpression of the p110 catalytic subunit of PI-3 kinase. Either IGF-1 pretreatment or PI-3 kinase overexpression restored ceramide-depleted catalase function, and this restoration was inhibited by wortmannin. A catalase inhibitor 3-amino-1h-1, 2, 4-triazole (ATZ) blocked the inhibitory action of IGF-1 on ceramide-induced apoptosis, whereas exogenous purified catalase enhanced it. Ceramide-activated caspase-3 was inhibited by IGF-1/PI-3 kinase and enhanced by wortmannin, while the addition of a specific caspase-3 inhibitor DMQD-CHO significantly enhanced the restoration by IGF-1 of ceramide-depleted catalase function. Moreover, IGF-1 inhibited C2-ceramide-induced decrease of mitochondrial membrane potential, and increase of cytochrome c release, caspase-3 cleavage and caspase-3 activity as judged by PhiPhiLux cleaving method. In summary, these results suggest that IGF-1/PI-3 kinase inhibited C2-ceramide-induced apoptosis due to relieving oxidative damage, which resulted from the inhibition of catalase by activated caspase-3.

A case of clinically and neuropathologically atypical corticobasal degeneration with widespread iron deposition

A 65-year-old woman was admitted to our hospital for forgetfulness, depression and eccentric behavior that had been first noticed 2 years prior to admission. She showed memory impairment, perseveration and repeated violent actions, but no limb-kinetic apraxia. She died 12 years after the onset of symptoms. At autopsy, the unfixed brain weighed 820 g. Atrophy was circumscribed in the frontal lobe on both sides. The globus pallidus and the caudate nucleus were markedly atrophic and gold yellow in color, and the substantia nigra was strikingly pale. The cortical area showed neuronal loss and status spongiosus of the second and third cortical layers with ballooned neurons. Marked neuronal loss was observed in the dorsomedial nucleus of the thalamus, Meynert basal nucleus and substantia nigra. With Holzer stain, fibrillary gliosis was found to be severe in the frontal lobe, globus pallidus, subthalamic nucleus, hippocampus, dorsomedial nucleus of thalamus, substantia nigra, pontine tegmentum and inferior olivary nucleus. With Bielschowsky-Hirano stain, neurofibrillary tangles were observed in the cortex, hippocampus, substantia nigra, dentate nucleus, subthalamic nucleus, pontine nucleus, the inferior olivary nucleus, dorsomedial nucleus of the thalamus and, to a lesser extent, the neostriatum. Strikingly numerous argyrophilic and tau-positive threads were present in the cerebral white matter. These neuropathological findings corresponded to corticobasal degeneration, but lesions characteristic of progressive supranuclear palsy were also found. Moreover, widespread iron deposition throughout the central nervous system was the most striking finding of the present case. To our knowledge, such a case has not been reported in the literature to date.

Interleukin-2-dependent but not independent T-cell lines infected with human T-cell leukemia virus type 1 selectively express CD45RO, a marker for persistent infection in vivo

Human T-cell leukemia virus type 1 (HTLV-1) is an etiologic agent of adult T-cell leukemia. HTLV-1 is exclusively detected in CD45RO+ T-cells in infected individuals, but CD45RO is weakly expressed in HTLV-1-transformed T-cell lines in vitro. The aim of this study was to investigate the role of CD45RO in the persistent HTLV-1 infection in vivo. Flow cytometry showed that only two out of eight interleukin(IL)-2-independent HTLV-1-transformed T-cell lines expressed CD45RO, whereas all five IL-2-dependent ones expressed CD45RO, and the level of expression was higher in IL-2-dependent than in IL-2-independent cells. The high CD45RO expression in IL-2-dependent cell lines was not due to IL-2, since IL-2 had little effect on the expression of CD45RO in T-cell lines. Using western blotting, we showed that IL-2-dependent HTLV-1-transformed T-cell lines expressed a lower level of expression of the viral transcriptional regulatory protein Tax than IL-2-independent ones, and that the level of expression correlated inversely with that of CD45RO. However, the expression of Tax in one HTLV-1-negative T-cell line little affected the expression of CD45RO, suggesting that Tax at least alone does not suppress the expression of CD45RO in HTLV-1-infected T-cell lines, and that other viral or cellular factor(s) are probably involved in such suppression. Our results suggest that CD45RO+ Tax-low IL-2-dependent T-cell lines in vitro correspond to the persistent HTLV-1-infected cells in vivo, and HTLV-1-infected cells in vivo are immortalized in IL-2-dependent manner.

The von Hippel-Lindau tumor suppressor protein mediates ubiquitination of activated atypical protein kinase C

The von Hippel-Lindau tumor-suppressor protein (pVHL) forms a protein complex (VCB-Cul2) with elongin C, elongin B, Cul-2, and Rbx1, which functions as a ubiquitin-protein ligase (E3). The alpha-subunits of the hypoxia-inducible factors have been identified as targets for the VCB-Cul2 ubiquitin ligase. However, a variety of cellular defects caused by the depletion of pVHL cannot be explained solely by the ubiquitin-mediated degradation of hypoxia-inducible factor-alpha. We show here that a member of the atypical protein kinase C (PKC) group, PKClambda, is ubiquitinated by the pVHL-containing E3 enzyme. An active PKClambda mutant is ubiquitinated more extensively than wild-type PKClambda in HEK293 cells, and the ubiquitination is further enhanced by the overexpression of pVHL. The activation of wild-type PKClambda by serum stimulation of cells enhances the ubiquitination of the protein, supporting the notion that active PKClambda is preferentially ubiquitinated by VCB-Cul2 ubiquitin ligase. Furthermore, we show that PKClambda can be ubiquitinated in vitro in a cell-free ubiquitination assay using purified recombinant components including VCB-Cul2. Given the known function of aPKC in the regulation of cell polarity and cell growth, PKClambda may be a target of pVHL in its function as a tumor suppressor.

[Chemical evaluation and consideration on the traditional drug "ULUUS" (2)]

Traditional patent medicine named "ULUUS" has been regarded to be the first Dutch precipitation with a western name in Japan. It was found that this drug consists of Rhubarb mainly, and it contained high amounts of effective compounds as for the traditional sample that has been stored for more than 100 years. In fact, a dose of this medicine was supposed to cause a laxative effect.

[Chemical evaluation and consideration on the traditional drug "ULUUS" (1)]

Traditional medicine named "ULUUS" is regarded to be the first Dutch precipation with a western name in Japan. It was found that this drug consists of Rhubarb (originated from Rheum sp.). Although it is still uncertain whether it was made only of Rhubarb by being kneaded hard into the monotonous square form, we could not find out any other ingredients except Rhubarb, on the bases of our chemical analysis.