Machine learning for layer-by-layer nanofiltration membrane performance prediction and polymer candidate exploration

In this study, machine learning-based models were established for layer-by-layer (LBL) nanofiltration (NF) membrane performance prediction and polymer candidate exploration. Four different models, i.e., linear, random forest (RF), boosted tree (BT), and eXtreme Gradient Boosting (XGBoost), were formed, and membrane performance prediction was determined in terms of membrane permeability and selectivity. The XGBoost exhibited optimal prediction accuracy for membrane permeability (coefficient of determination (R2): 0.99) and membrane selectivity (R2: 0.80). The Shapley Additive exPlanation (SHAP) method was utilized to evaluate the effects of different LBL NF membrane fabrication conditions on membrane performances. The SHAP method was also used to identify the relationships between polymer structure and membrane performance. Polymers were represented by Morgan fingerprint, which is an effective description approach for developing modeling. Based on the SHAP value results, two reference Morgan fingerprints were constructed containing atomic groups with positive contributions to membrane permeability and selectivity. According to the reference Morgan fingerprint, 204 potential polymers were explored from the largest polymer database (PoLyInfo). By calculating the similarities between each potential polymer and both reference Morgan fingerprints, 23 polymer candidates were selected and could be further used for LBL NF membrane fabrication with the potential for providing good membrane performance. Overall, this work provided new ways both for LBL NF membrane performance prediction and high-performance polymer candidate exploration. The source code for the models and algorithms used in this study is publicly available to facilitate replication and further research. https://github.com/wangliwfsd/LLNMPP/.

HPV Circulating Cell-Free DNA Kinetics in Cervical Cancer Patients Undergoing Definitive Chemoradiation

PURPOSE/OBJECTIVE(S)

The human papilloma virus (HPV) is a significant cause of cervical cancer and viral DNA can be detected in the blood of patients with cervical cancer (cfHPV-DNA). We hypothesized that detecting HPV cfDNA before, during and after chemoradiation (CRT) could provide insights into disease extent, clinical staging, and treatment response.

MATERIALS/METHODS

Forty-seven patients with cervical cancer were enrolled on this study between 2017 and 2022, either as part of a standard-of-care (SOC) treatment banking protocol (33 patients) or as part of a clinical trial combining a therapeutic HPV vaccine (PDS0101; Immunocerv, 14 patients). Longitudinal plasma samples were collected from each patient as baseline, during week 1, 3 or 5 of CRT. cfHPV-DNA was quantified using droplet digital PCR targeting the HPV E6/E7 oncogenes of 13 high-risk types based on analysis of cervical tumor genotype (AmpFire). Clinical covariates, including FIGO stage, primary tumor size, and treatment response were studied using appropriate statistical tests.

RESULTS

All 47 patients had detectable HPV cfDNA during CRT with 38 out of 47 having HPV type 16 detected. The median cfDNA at baseline was 24.5 copies/mL, with a range of 0 to 157,638 copies/mL. Of the 35 patients with at least three measurements, 20 (57%) had peak cfDNA counts at week 3, and 30 out of 35 showed a decline in cfDNA counts at week 5 compared to week 3. The proportion of patients who cleared cfDNA (<16 copies/mL) increased with each week of CRT, reaching 75% at week 5. Baseline cfDNA counts were associated with para-aortic nodal involvement (p<0.0001) but not with FIGO stage or gross tumor volume. A greater proportion of patients treated with therapeutic HPV-directed vaccine had clearance of cfDNA counts as compared to those treated with SOC (at week 3, 38% vs 5%, P = 0.02 and week 5, 79% vs 22%, P = 0.0054) CONCLUSION: HPV cfDNA levels change dynamically throughout definitive CRT and peak during the first 3 weeks for the majority of patients. Treatment with a therapeutic HPV vaccine was associated with a more rapid decline in cfHPV DNA. Further analysis of cfDNA kinetics could provide valuable information on the relationship between cfDNA levels, treatment response, and clinical outcomes.

Radiation Oncology Practice Changes during the COVID-19 Pandemic

PURPOSE/OBJECTIVE(S)

The purpose of this study was to characterize the effects of institutional policies routine SARS-CoV-2 testing before treatment starts with mandatory quarantine periods for COVID-positive patients during the first year of the COVID19 pandemic across radiation oncology sections at our tertiary cancer center.

MATERIALS/METHODS

Electronic medical databases were queried to identify all patients treated with curative intent at a large urban cancer center and regional satellites a year prior to the pandemic (02/11/19-12/30/19; pre-pandemic) and the first year of the pandemic (03/11/20-12/30/20; post-pandemic). New treatment starts were filtered for those undergoing treatment under a single ICD-10 diagnosis and the first treatment in each time period for each patient. Chi-square tests were used for categorical variables, and the t-test was used for continuous variables to correlate differences in demographic and clinical factors before and during the pandemic.

RESULTS

The total number of new treatment starts were similar between the pre-pandemic (2,218 patients) and post-pandemic (2,130 patients) periods, but there was a 26% decrease in treatments in April 2020 compared to April 2019 and a 40% increase in treatments in November 2020 compared to November 2019. Post-pandemic patients had higher minimum Charlson Comorbidity Index scores (mean 46.0 vs 42.6, P = 0.0013) and were younger (62.8 yo vs 64.3 yo, P = 0.0001). The proportion of patients being treated from the same state as our institution was higher in the post-pandemic period compared to pre-pandemic (77.8% vs 72.43%, P = 0.0259). Distribution of treatments across department disease-site sections were significantly different (P<0.0001), with the proportion of patients treated by the Breast service having increased by 22% whereas the metropolitan area regional satellites experienced a 18% reduction. There were no statistically significant differences amongst pre- and post-pandemic patients with respect to race, marital status, or smoking status. Post-pandemic patients had less total radiation-related clinical visits (mean 24.8 vs 28.6, P<0.0001), lower administered dose (4329 cGy vs 4533 cGy, P<0.0001), and lower radiation fraction count (17 vs 19, P<0.0001). There was no statistically significant difference in the duration between CT simulation and treatment start, but post-pandemic patients had shorter duration of elapsed days during treatment (27 days vs 29 days, P = 0.0001). A disease-site-specific analysis demonstrated that these differences were most pronounced in patients treated for breast cancer.

CONCLUSION

In the first year of the COVID19 pandemic, our institution saw a dynamic change in the number of new radiation treatments. Additional analyses across individual disease-specific services may reveal insight into dose, fractionation, and technique, which may account for the observed differences.

Augmented reality intravenous injection simulator based 3D medical imaging for veterinary medicine

Augmented reality (AR) is a technology which enables users to see the real world, with virtual objects superimposed upon or composited with it. AR simulators have been developed and used in human medicine, but not in veterinary medicine. The aim of this study was to develop an AR intravenous (IV) injection simulator to train veterinary and pre-veterinary students to perform canine venipuncture. Computed tomographic (CT) images of a beagle dog were scanned using a 64-channel multidetector. The CT images were transformed into volumetric data sets using an image segmentation method and were converted into a stereolithography format for creating 3D models. An AR-based interface was developed for an AR simulator for IV injection. Veterinary and pre-veterinary student volunteers were randomly assigned to an AR-trained group or a control group trained using more traditional methods (n = 20/group; n = 8 pre-veterinary students and n = 12 veterinary students in each group) and their proficiency at IV injection technique in live dogs was assessed after training was completed. Students were also asked to complete a questionnaire which was administered after using the simulator. The group that was trained using an AR simulator were more proficient at IV injection technique using real dogs than the control group (P ≤ 0.01). The students agreed that they learned the IV injection technique through the AR simulator. Although the system used in this study needs to be modified before it can be adopted for veterinary educational use, AR simulation has been shown to be a very effective tool for training medical personnel. Using the technology reported here, veterinary AR simulators could be developed for future use in veterinary education.

Protein kinase C mRNA and protein expressions in hypobaric hypoxia-induced cardiac hypertrophy in rats

AIM

Protein kinase C (PKC), cloned as a serine/threonine kinase, plays key roles in diverse intracellular signalling processes and in cardiovascular remodelling during pressure overload or volume overload. We looked for correlations between changes in PKC isoforms (levels and/or subcellular distributions) and cardiac remodelling during experimental hypobaric hypoxic environment (HHE)-induced pulmonary hypertension.

METHODS

To study the PKC system in the heart during HHE, 148 male Wistar rats were housed for up to 21 days in a chamber at the equivalent of 5500 m altitude level (10% O(2)).

RESULTS

At 14 or more days of exposure to HHE, pulmonary arterial pressure (PAP) was significantly increased. In the right ventricle (RV): (1) the expression of PKC-alpha protein in the cytosolic and membrane fractions was increased at 3-14 days and at 5-7 days of exposure respectively; (ii) the cytosolic expression of PKC-delta protein was increased at 1-5, 14 and 21 days of exposure; (3) the membrane expressions of the proteins were decreased at 14-21 (PKC-betaII), 14-21 (PKC-gamma), and 0.5-5 and 21 (PKC-epsilon) days of exposure; (4) the expression of the active form of PKC-alpha protein on the plasma membrane was increased at 3 days of exposure (based on semiquantitative analysis of the immunohistochemistry). In the left ventricle, the expressions of the PKC mRNAs, and of their cytosolic and membrane proteins, were almost unchanged. The above changes in PKC-alpha, which were strongly evident in the RV, occurred alongside the increase in PAP.

CONCLUSION

PKC-alpha may help to modulate the right ventricular hypertrophy caused by pulmonary hypertension in HHE.

Osteopontin expression in normal and hypobaric hypoxia-exposed rats

AIM

Experimental pulmonary hypertension induced in a hypobaric hypoxic environment (HHE) is characterized by structural remodelling of the heart and pulmonary arteries. Osteopontin (OPN) has emerged as a key factor in cardiovascular remodelling in response to pressure or volume overload. We studied the possible effects of HHE on the OPN synthesis system.

METHODS

One hundred and forty-eight male Wistar rats were housed in a chamber with conditions equivalent of an altitude of 5500 m for up to 21 days.

RESULTS

Plasma OPN protein level was found to be significantly decreased on day 0.5 of exposure to HHE, as was the level in the adrenal gland (which secreted highest levels of OPN protein). In the right ventricle of the heart (mRNA) and the lung (protein), OPN expression was found to be significantly increased only on day 1 and day 5, respectively, of exposure to HHE. By immunohistochemistry, the distribution and intensity of OPN protein in several organs were found to alter during exposure to HHE. However, these changes in OPN synthesis did not coincide with the moderate increase in pulmonary arterial pressure (PAP) (maximal mean PAP, 24.5 mmHg) during HHE.

CONCLUSION

Pulmonary hypertension in HHE with conditions equivalent of an altitude of 5500 m may induce little or no OPN in heart and lung. Sustained induction may require a more severe PAP overload.

Melt agglomeration with polyethylene glycol beads at a low impeller speed in a high shear mixer

This study was performed in order to evaluate the possibility of obtaining spherical agglomerates with a high content of meltable binder by a melt agglomeration process in a high shear mixer. Lactose monohydrate was melt agglomerated with polyethylene glycol (PEG) 1500 or 6000 in a 10-l high shear mixer at an impeller speed of 400 rpm. The PEG 1500 was used as a size fraction of beads, and the PEG 6000 as a fine powder, a powder, unfractionated beads, and size fractions of beads. It was found to be possible to incorporate a high amount of PEG (28% m/m of the amount of lactose), because the rather low impeller speed applied in the present experiments caused less densification of the agglomerates. The fine powder of the PEG 6000 caused a complete adhesion of the mass to the bowl shortly after melting. A rapid agglomerate growth by coalescence was found to be the dominant growth mechanism when agglomeration was performed with the PEG 6000 powder. The PEG beads resulted in a slow and more controllable agglomerate growth, because the growth occurred primarily by an immersion of the lactose particles in the surface of the molten binder droplets. The initial shape of the agglomerates produced with the PEG beads was similar to the spherical shape of the beads. This shape could not be maintained during the process due to a breakage of the agglomerates caused by a hollow structure of the PEG beads.

[Percutaneous cryosurgery for liver tumors]

A new cryoprobe developed in our department makes it possible to perform percutaneous cryoablation for small liver tumors. This cryoprobe is placed into each lesion using an ultrasonic guidance technique. In this study there were 10 patients with hepatocellular carcinoma and 5 patients with liver metastases from colorectal carcinoma. In 6 cases the tumor size was below 2 cm, in 6 cases between 2 and 3 cm, and in 3 cases over 3 cm. Using a cryoprobe of 3 mm in diameter, each lesion was frozen using liquid nitrogen for 15 or 20 minutes then thawed for 10 minutes, and repeated. The ice ball was found to enlarge to 3 cm in 20 minutes and 5 cm in 60 minutes experimentally. Six cases were CR, 5 PR, 2 NC and 2 PD. After cryoablation, liver function did not change and there were no complications. However, as the size of the ice ball was small (about 3 cm), this method was insufficiently effective in some cases. Percutaneous cryoablation using this probe should be performed for tumors smaller than 3 cm.

Measuring lower leg swelling: Optimum frequency for impedance method

The optimum measuring frequency of the impedance plethysmograph is determined for the estimation of leg volume increase caused by a sitting work load. Ten subjects sit for 1 h without leg movement. Right calf impedance is measured by the four-electrode method. The detecting electrodes are fixed on the calf with an inter-electrode distance of 15 cm. The measuring frequencies are 5, 10, 50 and 100 kHz. As the indices of leg swelling, three values are calculated: percentage change in impedance, volume change and percentage change in volume. The mean, standard deviation and coefficient of variation (CV) are calculated from the mean values of indices for each subject and frequency. The CV of all three indices increases when measurements are taken at higher frequencies. Among the three indices across all measuring frequencies, the volume change shows the highest CV (0.42 at 5 kHz, 0.82 at 100 kHz), and the percentage change in impedance shows the lowest CV (0.32 at 5 kHz, 0.72 at 100 kHz). It is concluded that the measuring frequency of 5 to 10 kHz is the best to obtain accurate data for the evaluation of lower leg swelling.

[Graft replacement of transverse aortic arch using the arch vessels first technique]

In surgical treatment of aortic arch aneurysm or aortic dissection, we have been employing retrograde cerebral perfusion (RCP). In the present study, we have developed "arch vessels first technique" to shorten perfusion time and achieved an excellent clinical outcome. The surgical procedure "arch vessels first technique" is outlined as follows. RCP is initiated following circulatory arrest, while a woven dacron graft (12 mm in diameter, the dacron graft must be prepared in advance) with two side arms (12 mm in diameter, i.e., with the same diameter) is anastomosed left subclavian artery, left common carotid artery and right brachiocepharic artery in a sequential manner. Then, brain circulation is initiated via one end of the dacron graft. Subsequently, in patients with aortic dissection, a 26 mm woven dacron tubular prosthesis is inserted, using an elephant trunk procedure, to perform "distal anastomose". A partial clamp is applied to the 12 mm woven dacron graft mentioned above, while this 26 mm graft is anastmosed to the 12 mm woven dacron graft side to side, thus reinitiating systemic circulation. While rewarming, the 26 mm woven dacron tubular prosthesis is proximal anastomosed. Mean RCP time was 79.4 minutes, using the conventional procedure "aortic arch distal anastomose", whereas the RCP time was shortened by this procedure "arch vessels first technique", as evidenced by mean RCP time of 57 minutes for patient with aortic dissection and of 39 minutes for patient with saccular aneurysm.

Efficacy of long-term azathioprine for relapsing nephrotic syndrome

Seven patients who had an initial attack of nephrotic syndrome in childhood and had frequent relapses even after cyclophosphamide therapy were given a 2-year course of azathioprine. The mean annual relapse rates decreased from 2.4+/-0.5 in the year preceding azathioprine to 0.4+/-0.8 in the 1st and 2nd years after its initiation. All six patients who were observed for more than 6 months after discontinuation of the therapy were relapse free for this period. Average doses of prednisolone could also be decreased in the 2nd and subsequent years after the therapy. There were no significant toxic effects. Long-term azathioprine therapy may be well tolerated and effective for nephrotic patients with frequent relapses.

NMR microscopy of the uptake, distribution and mobility of dissolution media in small, sub-millimetre drug delivery systems

NMR techniques were used to study the drug release process from small (sub-mm) lipophilic matrix theophylline beads. NMR microscopy was used to follow the ingress of the dissolution medium into the beads. Pulsed gradient spin echo (PGSE) NMR and 3D NMR imaging were used to measure the mobility and distribution of liquid within fully liquid penetrated beads. These techniques were used to rationalise the increase in the drug release rate with increasing proportion of GMS (glycomonosaccharide):paraffin in the matrix composition. A well-defined penetrant front was seen to move towards the centre of the bead during the dissolution process and the rate of liquid uptake showed the same trend with increasing GMS content as the rate of drug release. The total concentration of absorbed liquid increased and its T(2) relaxation time decreased with increasing GMS content of the bead matrix. This combined with the interpretation of PGSE results suggested that liquid resides in the matrix material as well as in pores left by the dissolved drug, and that this tendency increases with increasing GMS content. Heterogeneities in liquid distribution within the beads were quantified using percolation analysis and were related to the lipid matrix composition and may be a contributory factor in determining the rate of drug release.

[Surgical repair of postinfarction ventricular septal defect: modified Komeda-David procedure]

Since Cooley first reported surgical repair of postinfarction ventricular septal defect in 1957, there have been technical improvements in this procedure. However, the outcome of surgery has not been gratifying thus far. In 1990, Komeda and associates reported a single patch of bovine pericardium sutured to the healthy myocardium around the infarcted area on the left side of the septum that excludes the infarcted myocardium from the left ventricular cavity; a procedure based on a completely different idea. Since the satisfactory outcome of the surgical treatment in this procedure was obtained in a series of 12 patients, this surgical procedure has been in widespread use in Japan. On the other hand, this procedure has a drawback that there is a difficulty in suturing the patch and may lead to a postoperative residual shunt. We investigated a modified surgical procedure that could overcome this difficulty and would like to report it in this paper. At first, the perforated area should be covered with a felt strip and closed with mattress sutures. Secondly, the infarcted myocardium from the left ventricular cavity should be obliterated using a two-patch method. The primary advantage of this procedure is that it achieves a broader range of vision than a single patch method and enables easy suturing. Additionally, the development of a residual shunt can be prevented owing to the closure of perforation even if sutures fail to hold and leakage occurs. The tow-patch method has the advantage of avoiding tension against sutures since the patch is not everted around the sutures. However, the question arises whether only the healthy myocardium can be picked out and sutured without fail. In order to make the two-patch method more reloable the perforation should be closed in advance.

[Estimation of left internal thoracic artery flow reserve after coronary artery bypass grafting using Doppler flow wire]

The usefulness of the left internal thoracic artery (LITA) for aortocoronary bypass grafting is now established. Reports of variation in LITA graft function are rare. Graft flow was measured using a Doppler flow wire to estimate graft function in 27 patients (24 males, 3 females) who underwent LITA grafting to the left anterior descending artery. Patients were classified into the following 3 groups: Group A consisted of 9 patients with normal left ventricular function and no native flow; Group B consisted of 11 patients with normal ventricular function and good native flow; Group C consisted of 7 patients with abnormal left ventricular function and no native flow. LITA graft function was also estimated 1 year after operation in 12 of these 27 patients (4 in each group). Diastolic/systolic velocity ratio (DSVR) and flow reserve were determined in the proximal, middle, and distal portions of the LITA graft and native left anterior descending artery before and after papaverine administration (8-10 mg). DSVR was significantly higher in the distal portion than in the proximal portion (p < 0.01), but this value did not change after papaverine administration. After 1 year, DSVR in the proximal portion was significantly higher in Group C than in Groups A or B (p < 0.05 for both). Four weeks after operation, the flow reserve of the distal portion was significantly higher in Group A than in Group C (p < 0.001). After 1 year, this value was significantly higher in Group A than in either Groups B or C (p < 0.01, p < 0.001, respectively). The rate of increase in flow reserve in the distal portion was significantly greater in Group A (23.4%) than in groups B (2.53%) or C (1.94%; p < 0.05 for both). The distal portion of the LITA was the best measurement site, since the flow pattern in the LITA graft varied throughout all portions. Diastolic flow velocity in the LITA graft was dominant in patients with myocardial damage. The results indicate that flow reserve of the LITA graft depends on antegrade native coronary flow and distal myocardial damage.

Enhancement of B7-1 (CD80) expression on B-lymphoma cells by irradiation

Irradiation of A20.2J mouse B-lymphoma cells enhanced their antigen-presenting ability to induce interleukin-2 (IL-2) production by 42-6A T cells specific for ovalbumin (OVA)323-339/I-Ad. Irradiated and fixed A20.2J cells were more efficient antigen-presenting cells (APC) to present OVA323-339 peptide than the unirradiated and fixed cells. Irradiation selectively increased the expression of B7-1 molecules, but not of the major histocompatibility complex class II molecules, B7-2, lymphocyte function-associated antigen-1, or intracellular adhesion molecule-1. Irradiation of A20.2J cells with 100 Gy followed by overnight incubation was optimal for the enhancement of B7-1 expression. Anti-B7-1 monoclonal antibody inhibited the irradiation-induced enhancement of APC function. Irradiation of A20.2J cells induced the accumulation of B7-1 mRNA. Thus, it was concluded that the enhancement of APC function by irradiation was due to the up-regulation of B7-1 molecules through the accumulation of its mRNA. Although partial inhibition of protein synthesis has been shown to enhance the accumulation of B7-1 mRNA and its expression, irradiation did not decrease the protein synthesis in A20.2J cells. The incubation with irradiated A20.2J cells stimulated unirradiated A20.2J cells to increase B7-1 expression, suggesting that irradiation of A20.2J cells induced expression or secretion of some molecule(s) to enhance B7-1 expression.

[Operation for left renal cell carcinoma complicated with acute pulmonary tumor embolism and cocurrent removal of tumor]

The prognosis of pulmonary tumor embolism is said to be poor and only a limited number of patients with this disease have survived. The patient was a 64-year-old male suffering from left renal cell carcinoma complicated with tumor extending from the left renal vein to the inferior vena cava. The patient underwent an operation for left renal cell carcinoma during which he developed tumor embolus to the pulmonary artery. The occurrence of the acute embolism was promptly detected and the removal of tumor was performed under cardiopulmonary bypass. The patient made good postoperative progress.

[Load on the low back of teachers in kindergartens]

In order to evaluate the load on the low back of teachers in kindergartens, basic activity and working posture were analyzed for four teachers by means of video recording. The trunk inclination angle (TIA) was also measured continuously during full workshifts for 12 kindergarten teachers by means of an inclination monitor. The kindergarten teachers spent 67% of the workshift on activities in contact with children, "indoor group childcare", "indoor free playing", "outdoor childcare", "preparation and clearing away" and "help and care", and did not take a recess during the workshift. They spent 36% of the workshift in three working postures with the load on the low back, "standing bent forward", "squatting" and "kneeling". Cumulative time at a TIA of 20 degrees or more represented 43% of the workshift. The frequency of trunk-lifting from severe bending forward (TIA > 45 degrees) was 95 times/hr on average. A comparison of the kindergarten teachers and nursery teachers in 4-5 year age classes showed that the time distributions of basic activities were generally similar to each other. Although the time distributions of working postures were also similar, time spent "standing bent forward", "squatting" and "kneeling" was longer in the kindergarten teachers than in the nursery teachers. Cumulative time at a TIA of 45 degrees or more was significantly longer in the kindergarten teachers. Although the frequency of trunklifting was not significantly different, the kindergarten teachers tended to lift their trunk more frequently. The present study found that the load on the low back was considerably great in the kindergarten teachers.

[An experience with St. Jude medical prosthetic 19A-HP which resulted in restricted opening at an early stage after operation]

St. Jude medical hemodynamic plus series is positively used for aortic valve replacement (AVR) of small orifice because it can increase the orifice area by 26% compared with conventional prosthetic valves of the same size. We performed AVR with SJM 19A-HP on a patient having aortic stenosis with regurgitation using horizontal mattress suturing technique. The aortic orifice size was 18.9 mm at the preoperative measurement. The course after the operation was uneventful until 9 days after the operation when cinefluoroscopy revealed symmetrical restriction of opening of valve leaflets. We are now monitoring the clinical course at the patient has not developed any symptoms though the LV-Ao pressures gradient is 60 mmHg by Doppler echocardiography. As the restriction of valve leaflet opening was symmetrical, it is not likely that an excess of the ligature or remnant caused the restriction; structural problems of St. Jude medical prosthesis appear to be a more reasonable explanation. Since the orifice ring of this prosthesis is not reinforced, longitudinal forces applied to the hinge may alter the shape of the ring, thus restricting the movement of valve leaflets. In the present case, forced insertion of 19A-HP instead of more desirable 17-HP is considered to have caused longitudinal forces acting on the hinge.

[Replacement of the aortic root with woven and knitted Dacron composite graft]

Some of the patients with annuloaortic ectasia or Stanford type A require aortic root replacement. If conventional Bentall procedure is employed in such cases, aortic root will become a cylindrical shape totally lacking sinus of Valsalva because the procedure utilizes a straight tube. The sinuses of Valsalva support an important role in opening and closing the valvar leaflets, and opening of the coronary arteries, together with the interleaflet triangles and the sinutubular junction. In this study, we performed aortic root replacement with composite graft which consisted of two types of graft including 30 mm Knitted Dacron Graft (Gelsoft) with different dilation rates and 30 mm Woven Dacron Graft (Hemashield) as well as bioprosthesis (27 mm Carpentier-Edwards), in order to reconstruct sinus of Valsalva. Post-operative angiography revealed an excellent diastolic coronary flow, as evidenced by proximal Knitted graft of 37 mm in diameter, distal Woven graft of 30.3 mm in diameter and Doppler flow DSVR (Diastolic/Systolic Velocity Ration) of 2.2 measured at the left coronary orifice. Since it is difficult to obtain homograft at present, this procedure would be worth trying during aortic root replacement.

Trunk rotation monitor using angular velocity sensors

To monitor the low back risk imposed by asymmetric postures at workplaces, a method using angular velocity sensors was studied. According to a simple model analysis, trunk rotation could be calculated from the angular velocities measured at both the waist and shoulder and from the inclination of each angular velocity sensor. We thus developed a new detector consisting of an angular velocity sensor (ENC-05D, Murata, Japan) for detecting angular velocity and an acceleration sensor (ADXL05, Analog Devices, USA) for measuring inclination. The precision of the angular velocity sensor was high as the correlation coefficient between the output of the sensor and the true value was 0.9996. When the detectors were affixed to a subject and compared with data measured by a Vicon System 370 (Oxford Metrics, UK), the correlation coefficients between the two methods were 0.949 and 0.815 during model tasks of box transfer and box lifting, respectively. In a model of lifting boxes at different rates, the mean and standard deviation increased according to the task speed. This method was shown to be of practical use for monitoring trunk rotation.

Molecular phylogenetic position of podostemaceae, a marvelous aquatic flowering plant family

Podostemaceae are aquatic herbs and are famous for their anomalous vegetative morphology, occurring only in rapids. Because of its peculiar morphology, there were no established theory nor accepted opinion on the phylogenetic position. Especially, Cusset and Cusset (1988) proposed the new class, Podostemopsida beside the Magnollopsida and Liliopsida. We, therefore, consequences extensive and detailled analyses using nucleotide sequences ofrbcL genes for two genera and three species of the family together with many representatives of the families of flowering plants to determine the closest ally. The conclusion was that the Crassulaceae is a sister group to the Podostemaceae.

Swell-preventing effect of intermittent exercise on lower leg during standing work

This study investigated the effectiveness of several possible exercises for performance during standing work in order to prevent lower leg swelling and relieve subjective complaints. Volume changes in the lower leg were measured using bioelectrical impedance plethysmography in 13 healthy male subjects aged 23-36 years. Subjective complaints of leg pain, leg dullness and whole body fatigue were also recorded. Measurements were performed at two-minute intervals during a one-hour period of standing with insertions of one-minute of exercise every 10 min. The exercises were knee-bending, foot-stepping, walking, and heel-raising. The change rates of impedance over one hour were 2.2%, 4.0%, 4.6%, and 6.3%, respectively, indicating that leg volume was increased under all exercise conditions. Among exercises, the swell-preventing effect of knee-bending was strongest, and that of heel-raising was weakest. Heel-raising also yielded the highest number of subjective complaints. Knee-bending, which uses the thigh and calf muscles simultaneously, was considered the most effective for suppressing lower-leg swelling and minimizing subjective complaints.

Load on the low back of teachers in nursery schools

In order to evaluate the load on the low back of teachers in nursery schools, basic activity, working posture, child-lifting, and desk-lifting were analyzed for eight nursery teachers using video recording. The trunk inclination angle (TIA) was also measured continuously during full workshifts for 20 nursery teachers using an inclination monitor. The nursery teachers in the 0-1 (year) age class more often adopted low working postures, "sitting on the floor" and "kneeling," while teachers in the 4-5 age class more frequently adopted high working postures, "standing" and "sitting on a chair." The mean of TIA among all subjects was 20 degrees. The time spent at a TIA of more than 20 degrees represented 43% of the workshift. The mean and time distribution of TIA did not differ between the age classes. The frequency of trunk-lifting from severe bending forward (TIA > 45 degrees) was 86 times/hour on average. The frequency of trunk-lifting was highest in the 0-1 age class. The number of times of child-lifting was 46 in the 0-1 age class, while it was 1 in the 4-5 age class.

Vasospastic angina in a patient with Fabry's disease who showed normal coronary angiographic findings

It has been reported that coronary diseases in patients with Fabry's disease are induced by deposits in endothelial cells and coronary smooth muscle cells. Most of those are ischemia due to stenosis. This report describes a case of patient with Fabry's disease who showed severe vasospasms without coronary artery stenosis during acetylcholine loaded coronary angiography. In this case, a myocardial biopsy revealed that the deposits in the endothelial cells of the myocardial capillaries were lamellated appearance. Recently, it is reported that endothelial cell damage could be an important cause of coronary vasospasm. This case suggests that the some sort of functional disorder was induced by glyco-sphingolipid deposits in the coronary endothelial cells, and that this might have led to coronary artery spasms without the organic stenosis of coronary arteries.

[Analysis of participation rates of atomic bomb survivors in health examinations]

Participation rates of atomic bomb survivors in health examinations were analyzed with a multiple logistic regression model. Rates were obtained for each stratum by sex, age group and residential ward. The effect of residential wards was considered in relation to the social indices of the wards. The effects of sex, age group and residential ward on participation rates were as follows: (1) Females had higher participation rates than males in the working age group (40-64). No sex differences were seen after age 65. (2) The participation rates had a peak around age 70 and were exceptionally high also in the youngest age group (40-44). (3) Participation rates were higher in suburban wards than in central wards. The participation rates had a negative correlation with urban characteristics while they had a positive correlation with suburban characteristics. In particular they had significant negative correlation to the number of clinics and positive correlation with voter participation rates in elections. These results suggest the need for a new type of urban health examination and reflection of the general attitude of the residents to the government.

Bioelectrical impedance measuring method for standing load evaluation

A bioelectrical impedance method was used to evaluate the workload in standing jobs. This method is designed to indirectly evaluate swelling of the lower leg by measuring the change in the rate of impedance of the lower leg. In this paper, we studied the relationship between the methods used for swelling evaluation, and studied the measuring conditions of the impedance method by using bioelectrical models. Furthermore, impedance in ten male subjects in three types of standing conditions was measured to check the validity of the model analysis. The results are as follows: 1) The result of theoretical analysis showed that the change in impedance caused by leg swelling is equal to the value obtained by the leg volume measuring method, and twice as great as the value obtained by the leg circumference measuring method. The rate of change in impedance at low frequency is about 4 times greater than that at high frequency. The low frequency impedance measuring method is therefore much more sensitive than the other methods. 2) The results of experimental studies showed that the impedance in the lower legs was reduced as the function of time when quietly standing for 30 mins. The change in the rate of impedance was 6.86 +/- 4.54% (mean +/- SD). This rate is 3-5 times greater than the data reported by other researchers who used volume measurement or impedance measurement at high frequency. This difference fits the results of model analysis, and proved the validity of model analysis and the usefulness of the impedance method as an index of the standing load.(ABSTRACT TRUNCATED AT 250 WORDS)

A simple apparatus using inclinometer for monitoring working postures

A new apparatus was developed for evaluating a load on the low back caused by working postures by measuring upper body inclination. This apparatus consists of an inclinometer and a portable unit. The inclinometer that uses a magnetic resistance sensor is attached to the upper body of the subject. The portable unit, controlled by a one-chip CPU, is enclosed in a cloth case and carried by the subject on his waist belt. The inclination is measured at a certain interval and recorded in the memory of the portable unit. All the recorded data are later transferred to a host computer and then analyzed. According to the theoretical analysis by using a simple mathematical model, upper body inclination changes according to the height of work places, and one cm difference in height causes more than one degree of upper body inclination. A model work of material handling was carried out to collect sample data. Two male subjects lifted ten boxes onto a platform from a stand in several heights. Both stooped and squat lifting methods were used as the lifting protocol. The mean and standard deviation (SD) of the upper body inclination during work decreased according to the lift distance only in stooped lifting. As a practical application, working postures during the task of changing diapers for handicapped people were analyzed with out apparatus. A female subject changed diapers eight times at different height of beds. The mean value of inclination decreased according to the height of the beds.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic efficacy of lanoconazole, a new imidazole antimycotic agent, for experimental cutaneous candidiasis in guinea pigs

The therapeutic efficacy of 1% cream and 1% solution of lanoconazole, a new imidazole antimycotic agent, in the model of cutaneous candidiasis in prednisolone-treated guinea pigs was evaluated in comparison with that of comparable formulations of bifonazole. Each preparation was topically applied once a day for 3 consecutive days, starting on the fifth day postinfection, and quantitative culture study wsa conducted on the ninth day postinfection. Both formulations of lanoconazole were much more highly effective in terms of eradication of fungi than the bifonazole formulations.

[Current and future perspectives of medical information network systems for community health using personal computers and IC cards]

Recent developments in computer and communication technology were studied in relation to medical information network systems, using computers and IC cards, to solve problems in community health. Trial use of personal computer network systems among physicians and IC card systems for personal health data management are already in existence in some parts of Japan. These trials were studied and analyzed based on a questionnaire survey of physicians and patients. Results of the study produced some useful points that should be considered when introducing these systems. These included: 1) details on expectations and specifications for these systems by physicians and patients, 2) easy access to valuable information is a key point for active network systems among physicians, 3) plausibility of improvement of communication between physicians and patients by using these systems, 4) recognition that an important problem concerns patient information privacy and must be considered before introducing these systems. A study of practical merits of these systems and methodology for realization indicates that participation by active and attractive providers of information can be expected to stimulate frequent use of the network system. The cost of introducing these systems can be partially borne by eliminating the large investment now allocated for processing requests for reimbursement of medical services. Investigation into the introduction of medical information systems provides a good opportunity to elucidate problems in the present medical systems.

Statistical analysis and prediction on incidence of infectious diseases based on trend and seasonality

We proposed a prediction methodology for the incidence of infectious diseases using incidence data on measles and influenza for forty years in Japan. We also proposed a diagram that makes it possible to convey information on infectious disease incidence more attractively to a wider audience. This can be a useful tool for health promotion in the community. The obtained results are as follows: 1. It was advantageous to use data transformed by logarithm in statistical analysis of infectious disease incidence. 2. The incidences of measles and influenza exhibited strong seasonality. Measles was most frequent in June and influenza in February. 3. Long-term trends were extracted from the derived data obtained by eliminating seasonal effects from the original data. For measles, a decline was accelerated by the introduction of vaccination program in 1978. Influenza also showed a decline for these thirty years. 4. The observed incidence data were quite well predicted by only the trend and the seasonality. The squares of multiple regression coefficients of measles and influenza were 0.84 and 0.58, respectively. The analysis of the residuals suggested there was a possibility of improvement in prediction. 5. The improvement in prediction was attained by incorporating an autoregressive component of the residuals. As a result, the squares of multiple correlation coefficients of measles and influenza increased to 0.97 and to 0.79, respectively. 6. We finally proposed the TS-decomposition diagram to facilitate practical use of incidence data. In this diagram, current incidence data and predicted values for the near future are plotted on the plane where the trend and the seasonality are superimposed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Analysis of measuring conditions of surface electromyogram using mathematical model]

To study the measuring conditions of surface electromyogram for work analysis in the field of industrial health, the effect of electrode fixation, electrode distance and electrode-muscle distance were studied using a mathematical model. The results were as follows; 1) The output waveforms of two electrode fixed models, i.e., parallel-fixed model (two electrodes were fixed in parallel to the direction of the muscle fibers) and transverse-fixed model (two electrodes were fixed in transverse to the direction of the muscle fibers) were compared. The maximum output and rectified integrated output of the parallel-fixed model were 2.59 times and 1.2-1.5 times larger than those of transverse-fixed model, respectively. The high output area of the parallel-fixed model was only one round area, but the areas of transverse-fixed model were four round areas which were wider than the area of the parallel-fixed model. The rectified integrated output of the parallel-fixed model was more affected by the location of neuro-muscular junction than that of transverse-fixed model when the electrodes were fixed near the neuro-muscular junction. 2) The rectified integrated output increased by electrode distance, and the changing rate of the rectified integrated output by electrode distance was particularly large when the electrode distance was shorter than 2 cm.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electromyogram measuring method for low back load evaluation of handling weight and forward bending posture]

In order to establish a measuring method of electromyogram (EMG) to evaluate the low back load by handling weight and forward bending angle. EMG at Th5-6, Th8-9, Th11-12, L1-2 and L3-4 were measured in ten male subjects. The handling weight was changed at 0, 10, 20 and 30 kg, and the forward bending angle was changed at 0, 30, 60 and 90 degree. The following results were obtained: 1) EMG increased according to the handling weight at all forward bending angles. The increasing rate of EMG at Th5-6 was larger than that at L1-2 or L3-4. Thus, EMG at higher position such as Th5-6 was found to be appropriate to evaluate handling weight-load. 2) The effect of forward bending angle was different by handling weight. EMG at L1-2 and L3-4 increased according to forward bending angle when the handling weight was 0 kg or 10 kg and when the forward bending angle was not greater than 60 degree. However, when the handling weight was 20 kg or 30 kg, EMG and forward bending angle did not show a simple proportional relationship. Thus, EMG at L1-2 or L3-4 could be used to evaluate posture load when the handling weight was light and the bending angle was not so large. However, it was difficult to use EMG to evaluate posture load when the forward bending angle was large or the handling weight was heavy.

Development of a system for analyzing working postures

In order to assist in the analysis of working postures which might cause lumbago in the field of industrial health, a system was developed for the synchronous recording and analyzing of postures, work content and physiological data. The system is composed of a portable unit for recording 3 channels of goniometers, 1 channel of inclinometer and 1 channel of surface electromyogram, a video camera for recording work content, a host computer and some peripheral devices for analyzing the data from the portable unit and video camera. In this system, postures are automatically classified from data on joint angles and upper body inclination angle by using a discriminant function. The joint angles are measured by the goniometers using rubber optical fibers. The angle of upper body inclination is obtained by the inclinometer using a magnetic resistance sensor. In addition to the work content and video images, the postures and the electromyogram can be analyzed and confirmed by simultaneous display of the data on the host computer screen. Based on the trial use of this system in a work model of manual baggage handling, it was proved useful for evaluating in detail the workload caused by working postures.

Sarcoidosis accompanied by pancreatic impairment

A 64-year-old male complained of weight loss and slight fever. Bilateral hilar lymphadenopathy and hepato-splenomegaly were observed. Serum ACE level was high, and liver function was impaired. Laparoscopy demonstrated small white nodules on the liver surface. A definite diagnosis of sarcoidosis was made by histological study of the specimen by liver biopsy and noncaseating epithelioid cell granulomas composed of giant cells and epithelioid cells were revealed. Various pancreatic enzymes were increased on admission, suggesting pancreatic impairment due to sarcoidosis. Corticosteroid therapy improved liver and pancreatic functions and decreased splenomegaly. He has been followed up for 4 years and 5 months.

[Development of posture measuring apparatus using goniometer and inclinometer. 2. Fixation, precision and calibration of goniometer]

A new posture measuring apparatus was developed for time and motion study in the field of industrial health. This apparatus records working postures by measuring angles of joints and trunk inclination. The angles of joints were measured by the newly developed goniometers which use the bending loss of rubber optical fibers. This paper presents results of studies made on the fixation, precision and calibration of goniometers which are important in the actual application of this apparatus. Six freedoms of five joints were examined, i.e. elbow (flexion/extension), shoulder (abduction/adduction and horizontal adduction/abduction), hip (flexion/extension), knee (flexion/extension), ankle (dorsi-flexion/plantar-flexion). The results obtained were as follows; 1) Goniometers should be fixed according to the characteristics of each joint. 2) The output errors were calculated from the measured data, excluding the effects of flexed angles, subjects and fixations. The mean output error of all joints was 0.189 V (14.3 degree). 3) The output errors by the three calibration methods using logistic curves were calculated. The output errors for 2-point method (calibrated by the data of minimum and maximum angles) and 3-point method (calibrated by the data of minimum, medium and maximum angles) were 1.34 and 1.22 times larger than the output errors (0.139 V) for all-point method (calibrated by all measured data), respectively.

[Effect of long-term feeding with tryptophan-free diet on the circadian rhythm in rats]

Effects of long-term feeding with tryptophan (TRP)-free diet on the free running periods of wheel-running rhythm and the central serotonergic neurotransmission were examined in male blinded rats. Long-term feeding with TRP-free diet did not change the periods of wheel-running rhythm calculated from chi 2 periodogram but disordered its pattern, which seemed to be due to masking or entrainment effects. On the other hand, long-term TRP-free diet decreased the concentrations of TRP, 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) in all brain regions tested; frontal cortex, hippocampus, thalamus, hypothalamus and pons. The density of 5-HT1A receptor (3H-8-OH-DPAT) binding was significantly decreased in only frontal cortex, while no significant change was observed in the density of 5-HT2 receptor (3H-ketanserin) binding in all regions. Although the mechanism of down-regulation of 5-HT1A receptor in frontal cortex is obscure, it was confirmed that TRP-free diet decreased central 5-HT synthesis and 5-HT neurotransmission. This dysfunction of 5-HT neurotransmission by TRP-free diet is suggested to make the circadian rhythm pacemaker susceptible to subtle environmental factors by lowering its intensity.

Determination of profiles of non-collagenous proteins from rat bones by sodium dodecyl sulfate high-performance liquid chromatography

Sodium dodecyl sulfate-high-performance liquid chromatographic (SDS-HPLC) techniques for screening profiles of bone non-collagenous proteins (NCP) are described and compared with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) techniques. NCPs were obtained from long bones of neonatal and mature rats by sequential extraction with 4 M guanidine hydrochloride (GdnHCl) and 0.25 M EDTA followed by desalting. Desalted extracts were subjected to SDS-PAGE and SDS-HPLC. The results of the two analyses were comparable. There were differences in NCP profiles between mature rats and pups and between the GdnHCl and EDTA extracts. The methods described can be used for qualitative comparison of treatments and as a basis for further study.

[Survey of attitudes among general practitioners regarding the introduction of a personal computer medical network system in community health care]

General practitioners (GPs) play an important part in community health care. Their opinion regarding introduction of a medical information network system using a personal computer and factors influencing the decision to introduce such a system were surveyed among 977 randomly sampled GPs. A response from 727 GPs was obtained. Based on a two stage selection method, 20 factors were selected as effective factors among the 73 factors surveyed, with the following results: (1) Responses to the question concerning the approval of system introduction were classified into three groups: "not necessary + too early to make a decision (DA)" (DA group), "approve (A)" (A group) and "undecided (UD)" (UD group). Each group had nearly equal numbers of respondees. (2) Significant effective factors were "experience with personal computers", "a desire to use a personal computer", "a desire to use a computer-diagnosis-system", "cost", and "a volition to operate a computer by himself". (3) The "A group" had high experience and affirmative opinions, while the "DA group" had low experience and negative opinions. The "UD group" also tended to respond with "do not know" regarding the factors. (4) Approval of system introduction requires providing basic knowledge on computers, opportunities for positive experience with computers, and practical examples of problem solutions in a general practitioner's work.

[Development of posture measuring apparatus using goniometer and inclinometer. 1. Description of the apparatus and its usefulness]

A new posture measuring apparatus was developed for time and motion study in the field of industrial health. This apparatus can record and classify working postures by measuring the angles of joints and trunk inclination. The angles of joints are measured by newly developed goniometers which use the bending loss of rubber optical fibers. The trunk inclination is measured by an inclinometer which uses photointerrupters. The measured angle data stored in the memory of this apparatus are transferred to the host computer and analyzed. Postures are classified automatically and subjectively according to discriminant functions which are calculated from the preliminarily measured data by discriminant analysis. Test measurement was carried out to classify four postures; standing, forward bending, half sitting and sitting. The goniometers were set on the right hip joint, knee joint, and ankle joint and the inclinometer was set on the right side of the trunk. The postures were changed in the order of standing, forward bending, half sitting, and sitting every 30 s. The angles were measured every second and a total of 120 sets of angles were measured. All data including data during posture changing were classified correctly by discriminant functions. The measurement during baggage lifting up and putting down was also carried out. Ten baggages (each 7 kg in weight) were lifted up from the floor onto a desk (75 cm in height), put down back to the floor, and again lifted on the desk. In 2 min, baggages were lifted up for a total of 20 times and put down for a total of 10 times.(ABSTRACT TRUNCATED AT 250 WORDS)