Writing 40 nm marks by using a beaked metallic plate near-field optical probe

We have developed a near-field optical probe that uses a triangular metallic plate with a three-dimensionally tapered apex as a light source for thermally assisted magnetic recording. Numerical analysis using a finite-element method shows that the size of the optical spot generated at the apex is 15 nm x 20 nm, and the efficiency (defined as the ratio between the power of the optical near field at the surface of the recording medium and that of the incident light) is 15% when the incident light is focused by a lens with a numerical aperture of 0.8. The metallic plate was fabricated on the surface of a quartz slider and used for writing marks on a phase change recording medium. The marks were observed with a scanning electron microscope, and we confirmed that marks with a diameter of 40 nm were successfully written on the medium.

Medical care expenditure associated with body mass index in Japan: the Ohsaki Study

OBJECTIVE

To examine the impact of body mass index (BMI) upon medical care use and its costs in Japan.

DESIGN

A population-based prospective cohort study from 1995 to 1998.

SUBJECTS

A cohort of 41 967 Japanese adults aged 40-79 y. Subjects who died during the first year of follow-up, or who at baseline reported having had cancer, myocardial infarction, stroke or kidney disease were excluded.

MEASUREMENTS

Medical care use and its costs, actual charges, by linkage with the National Health Insurance claim history files after adjustment of smoking, drinking and physical functioning status.

RESULTS

There was a U-shaped association between BMI and total medical costs. The nadir of the curve was found at a BMI of 21.0-22.9 kg/m(2). Relative to the nadir, total costs were 9.8% greater among those with BMIs of 25.0-29.9 (rate ratio, 1.10; 95% confidence interval (CI), 1.03-1.17), and 22.3% greater among those with BMIs of 30.0 or higher (rate ratio, 1.22; 95% CI, 1.08-1.37). Estimated excess direct costs attributable to overweight (BMI of 25.0-29.9 kg/m(2)) and obesity (BMI of 30.0 kg/m(2) or higher) represent 3.2% of total health expenditure in the present study, which is within the range reported in Western countries (0.7-6.8%).

CONCLUSION

Our prospective data demonstrate that the impact of overweight and obesity upon medical care costs in Japan is as large as in Western countries, despite the much lower mean BMI in Japanese populations.

A case of effective gastrostomy for severe abdominal distention due to breathing dysfunction of Rett's syndrome: a treatment of autonomic disorder

We report a case of 13-year-old-girl with Rett's syndrome and effectiveness of gastrostomy for severe paradoxical respiration, seizures and abdominal distention. Since the age of 3, she was observed to have typical hand-washing movement and autistic behavior. At the age of 8, she began to have hyperventilation and seizures in awake stage. Her symptoms were worse from year to year. At the age of 13, gastrostomy was done to treat severe abdominal distention. Her symptoms were improve dramatically by the gastric air removal through gastrobutton.

Rosai-Dorfman disease presenting with isolated bilateral orbital masses: report of two cases

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is a rare benign idiopathic proliferative disease of phagocytic histiocytes. Approximately 80% of patients present with painless massive cervical lymphadenopathy. Isolated extranodal involvement is relatively uncommon. Two cases of Rosai-Dorfman disease are reported: one with isolated bilateral orbital involvement and one with marked cervical lymphadenopathy and multiple dural-based and intraventricular masses.

Effects of exercise training on home blood pressure values in older adults: a randomized controlled trial

OBJECTIVE

To determine the effects of exercise training on the blood pressure (BP) values of older adults, using home blood pressure measurement.

DESIGN

Randomized controlled trial.

PARTICIPANTS

A total of thirty-nine free-living older adults (including 19 men) aged from 60-81 years with home systolic blood pressure > 120 mmHg and without significant cardiopulmonary-musculoskeletal disease, were randomly allocated to either 25 weeks of exercise training (exercise group) or to a control program (control group).

MAIN OUTCOME MEASUREMENTS

Change in the 2-week averages of home systolic and diastolic blood pressure values measured with a validated automatic device before, during and after the intervention period.

RESULTS

Compared with the control group, the exercise group showed a significant decrease in values for home systolic blood pressure (maximum between-group difference = 7.7 mmHg, P = 0.003) and home diastolic blood pressure (4.2 mmHg, P = 0.001). These changes were observed for both genders.

CONCLUSIONS

Exercise training was effective for older adults in lowering home blood pressure values. This is the first trial to demonstrate the usefulness of home blood pressure measurement in examining the effect of exercise training on blood pressure values.

Penetration of minocycline hydrochloride into lung tissue and sputum

Penetration of minocycline hydrochloride (MINO) into lung tissue and sputum was investigated. MINO (100 mg) was intravenously infused over 30 min to 14 patients before lung surgery: the concentration of MINO was determined in 16 lung tissue samples which were collected between 0.25 and 5.0 h after infusion. The mean concentration of MINO in lung tissue sample was 2.92 +/- 1.43 microg/g, and the mean lung tissue/plasma ratio of MINO concentration was 3.71 +/- 2.36. MINO was infused intravenously over 60 min twice daily to 5 patients with a chronic respiratory disease for 3-7 days. The concentration of MINO in sputum and in serum was determined on day 3. The mean maximum concentration of MINO in sputum sample was 2.12 +/- 2.20 microg/g, and the mean sputum/serum ratio of MINO concentration was 0.56 +/- 0.47. The concentration of MINO in sputum showed little time-related variation and remained as high as 0.74 microg/g until 10 h after infusion. The concentration of MINO in sputum and in serum after intravenous drip infusion was about twice as high as that after oral administration at the same dose. The breakpoint was 1.88 for MINO, as calculated by the formula established by the Japan Society of Chemotherapy.

[A study of measles encephalitis with focal changes on MRI, auditory agnosia and expressive aphasia]

Acute measles encephalitis is a typical parainfectious encephalitis in which the brain is diffusely affected clinically and neuropathologically. We present here a 5-year-old case of measles encephalitis with intractable seizures, bitemporal MRI abnormalities, and neurological sequelae of auditory agnosia and aphasia. Pathophysiology of the focal MRI lesions and of expressive aphasia due to auditory agnosia was discussed. We stressed that the status convulsions and its ischemic effect played an important role on the development of the focal lesions rather than focal encephalitis or ADEM. In the course of auditory agnosia and acquired aphasia, the patient transiently expressed some meaningful words. The significance of this episode was discussed based on the sequential changes of symptoms and neuroimaging findings.

Phylogenetic affiliation of the pseudomonads based on 16S rRNA sequence

The broad and vague phenotypic definition allowed the genus Pseudomonas to become a dumping ground for incompletely characterized polarly flagellated, gram-negative, rod-shaped, aerobic bacteria, and a large number of species have been accommodated in the genus Pseudomonas. The 16S rRNA sequences of 128 valid and invalid Pseudomonas species, which included almost valid species of the genus Pseudomonas listed in the Approved Lists of Bacterial Names, were obtained: sequences of 59 species were determined and those of 69 species were obtained from the GenBank/EMBL/DDBJ databases. These sequences were compared with the sequences of other species of the Proteobacteria. Fifty-seven valid or invalid species including Pseudomonas aeruginosa (type species of the genus Pseudomonas Migula 1894) belonged to the genus Pseudomonas (sensu stricto). Seven subclusters were formed in the cluster of the genus Pseudomonas (sensu stricto), and the resulting clusters conformed well to the rRNA-DNA hybridization study by Palleroni (1984). The other species did not belong to the genus Pseudomonas (sensu stricto) and were related to other genera, which were placed in four subclasses of the Proteobacteria (alpha, beta, gamma and gamma-beta subclasses). Twenty-six examined species, which were not included in the cluster of the Pseudomonas (sensu stricto) and have not been transferred to other genera as yet, are listed alphabetically: 'Pseudomonas abikonensis', Pseudomonas antimicrobica, Pseudomonas beijerinckii, Pseudomonas beteli, Pseudomonas boreopolis, 'Pseudomonas butanovora', Pseudomonas carboxydohydrogena, Pseudomonas cissicola, Pseudomonas doudoroffii, Pseudomonas echinoides, Pseudomonas elongata, Pseudomonas flectens, Pseudomonas geniculata, Pseudomonas halophila, Pseudomonas hibiscicola, Pseudomonas huttiensis, Pseudomonas iners, Pseudomonas lanceolata, Pseudomonas lemoignei, Pseudomonas mephitica, Pseudomonas pictorum, Pseudomonas saccharophila, Pseudomonas spinosa, Pseudomonas stanier, Pseudomonas syzygii and Pseudomonas woodsii. The phylogenetic affiliations of these 26 pseudomonads species are shown.

Relationship between health practices and education level in the rural Japanese population

Past studies in Europe and the USA have found that people with higher education levels have better health practices. The aim of this study was to examine the association between health practices and education level among people in a rural Japanese community. Data were derived from the Ohsaki National Health Insurance Cohort Study, which has been following 52,029 NHI beneficiaries, aged 40 to 79 years, in Miyagi Prefecture, Japan. The relationship between education level and seven health indices (smoking, drinking, body mass index, sleeping, exercise, breakfast, and snacks) was analyzed. Higher education was associated with shorter sleeping hours for both men and women, and lower BMI for women. In age groups younger than 70 years, people with higher education tended to exercise more. Smoking for women, alcohol consumption, and a Health Practices Index were not related to education levels. These results are different from those from Europe and the USA. This study suggest that the relationship between health practices and education level is weaker in Japan than in Europe and the USA.

Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer

PURPOSE

To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT).

METHODS AND MATERIALS

Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose-volume histograms. The recurrences were classified as 1) "in-field," in which 95% or more of the recurrence volume (V(recur)) was within the 95% isodose; 2) "marginal," in which 20% to 95% of V(recur) was within the 95% isodose; or 3) "outside," in which less than 20% of V(recur) was within the 95% isodose.

RESULTS

With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences (including one noninvasive recurrence) and 1 stomal recurrence were seen in 12 patients, for a 2-year actuarial local-regional control rate of 79% (95% confidence interval 68-90%). Ten patients (80%) relapsed in-field (in areas of previous gross tumor in nine patients), and two patients developed marginal recurrences in the side of the neck at highest risk (one in the high retropharyngeal nodes/base of skull and one in the submandibular nodes). Four regional recurrences extended superior to the jugulodigastric node, in the high jugular and retropharyngeal nodes near the base of skull of the side of the neck at highest risk. Three of these were in-field, in areas that had received the dose intended for subclinical disease. No recurrences were seen in the nodes superior to the jugulodigastric nodes in the side of the neck at less risk, where RT was partially spared.

CONCLUSIONS

The majority of local-regional recurrences after conformal and segmental IMRT were "in-field," in areas judged to be at high risk at the time of RT planning, including the GTV, the operative bed, and the first echelon nodes. These findings motivate studies of dose escalation to the highest risk regions.

Conformal and intensity modulated irradiation of head and neck cancer: the potential for improved target irradiation, salivary gland function, and quality of life

PURPOSE

To develop techniques which facilitate sparing of the major salivary glands while adequately treating the targets in patients requiring comprehensive bilateral neck irradiation (RT).

PATIENTS AND METHODS

Conformal and static, multisegmental intensity modulated (IMRT) techniques have been developed. The salivary flow rates before and periodically after RT have been measured selectively from each major salivary gland and the residual flows correlated with glands' dose volume histograms. Subjective xerostomia questionnaires have been developed and validated. The pattern of local-regional recurrences has been examined using CT scans at the time of recurrence, transferring the recurrence volumes to the planning CT scans and regenerating the dose distributions at the recurrence sites.

RESULTS

Target coverage and dose homogeneity in IMRT treatment plans were found to be significantly better than standard RT plans. Significant parotid gland sparing was achieved. The relationships among dose, irradiated volume and saliva flow rates from the parotid glands were characterized by dose and volume thresholds. A mean dose of 26 Gy was found to be the threshold for stimulated saliva. Subjective xerostomia was significantly reduced in patients irradiated with parotid sparing techniques, compared to patients with similar tumors treated with standard RT. The large majority of recurrences occurred inside high-risk targets.

CONCLUSIONS

Tangible gains in salivary gland sparing and target coverage are being achieved and an improvement in some measures of quality of life is suggested by our findings. A mean parotid gland dose of < or = 26 Gy should be a planning objective if significant parotid function preservation is desired. The pattern of recurrence suggests that careful escalation of the dose to targets judged to be at highest risk may improve tumor control.

Randomized controlled trial of exercise training for older people (Sendai Silver Center Trial; SSCT): study design and primary outcome

Physical exercise is expected to improve and maintain physical function in older people, thus promoting health and preventing or postponing the onset of disability in later life. The Sendai Silver Center Trial (SSCT) was a randomized controlled trial designed to evaluate the efficacy of exercise training among healthy free-living older people. Sixty-five eligible participants, aged from 60 to 81 years, were randomly allocated to an exercise group or a control group. The subjects in the exercise group were asked to attend training classes at the Sendai Silver Center, a municipal health and welfare facility in the center of Sendai City, at least twice a week for 25 weeks. Each training class, lasting two hours, started with a warm-up session, followed by an endurance session with a bicycle ergometer, and a resistance exercise training session using rubber films, and ended with a cool-down session. The subjects in the control group were asked to attend recreational classes at the Center twice a month. There were no drop-outs or accidents during the intervention. Comparison of maximum oxygen consumption (VO2max) before and after the 25-week intervention revealed a significant increase in the exercise group (2.1 ml/kg/min) but no significant change in the control group. Our result is equivalent to the participants becoming younger in aerobic capacity by five years after six months of exercise training.

MRA contrast bolus timing with ultrasound bubbles

The purpose of this study was to determine the feasibility of using an ultrasound contrast agent test bolus to determine optimum bolus timing for three-dimensional (3D) gadolinium (Gd)-enhanced magnetic resonance angiography (MRA). Small test doses of ultrasound contrast agent (0.3 ml Optison) were injected intravenously followed immediately by a 20 ml saline flush. Arrival of the contrast agent was detected by spectral Doppler ultrasound (US). This technique was implemented in patients undergoing peripheral vascular MRA and carotid MRA. Arrival of the US contrast agent test bolus was readily detected by the change in amplitude of the Doppler spectrum and by a huge increase in the audio signal amplitude. This contrast travel time measurement accurately guided bolus timing for 3D Gd MRA. Bolus timing for 3D contrast-enhanced MRA can be performed using US, thereby eliminating the problems and MR scanner time required for injecting a test bolus of Gd contrast.

Head and neck cancer: detection of recurrence with three-dimensional principal components analysis at dynamic FDG PET

Fully automated principal components analysis (PCA) was applied to dynamic 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomographic (PET) images obtained in 15 patients with previously treated head and neck cancer. PCA with time-activity curves incorporated kinetic information about FDG uptake, which improved tissue characterization on FDG PET images. The combination of standardized uptake value and PCA image sets likely will improve the reliability of tumor detection in head and neck cancers.

Application of new imaging techniques for the evaluation of squamous cell carcinoma of the head and neck

The past several years have seen dramatic changes in imaging of the head and neck. Technical improvements in CT and MRI coupled with their widespread availability have made cross-sectional imaging an important adjunct in evaluation of patients with disease of the extracranial head and neck. The most recent advances in head and neck imaging are from new metabolic and functional imaging techniques. The intent of this report is to provide an update on the potential role of positron emission tomography, new MRI agents, and magnetic resonance spectroscopy for evaluating squamous cell carcinoma of the extracranial head and neck.

Lung carcinoma in patients age younger than 30 years

BACKGROUND

To the authors' knowledge, no study regarding lung carcinoma patients age <30 years has been published. Therefore, this study was undertaken to define the characteristics of lung carcinoma patients age <30 years.

METHODS

Information regarding 26 patients with primary lung carcinoma who were age <30 years was obtained from 10 medical institutions and reviewed retrospectively. For comparison, 304 patients age > or = 30 years who were admitted to the First Department of Internal Medicine at Toyama Medical and Pharmaceutical University between 1980-1996 were studied.

RESULTS

Among the characteristics observed in the group of lung carcinoma patients age <30 years was a high incidence of female gender, no history of smoking, so-called "low grade malignancy," American Joint Committee on Cancer Stage I disease, and previous surgical resection. In addition, a low incidence of squamous cell carcinoma was noted, and a more favorable prognosis was observed.

CONCLUSIONS

The current study noted clinical features that could be defined clearly in lung carcinoma patients age <30 years.