Association between sleep duration and a new onset of nonalcoholic fatty liver disease

Objective A short sleep duration is associated with non-alcoholic fatty liver disease (NAFLD). However, the causal relationship between a short sleep duration and the onset of NAFLD remains unknown because of the lack of any longitudinal studies. Therefore, we evaluated the association between sleep duration and the onset of NAFLD. Methods We evaluated health checkup data for 1,862 NAFLD-free Japanese adults aged 33-86 years at baseline and followed those individuals for a median of 41 months. Hepatic steatosis was examined using ultrasonography (US). The Cox proportional hazards model was used to evaluate the association between sleep duration and NAFLD onset. Results Among the 1,862 participants, 483 (25.9%) developed NAFLD. The proportion of women who developed NAFLD was the highest in the group with a sleep duration of <6 hours and lowest in the group with a sleep duration of 7 to <8 hours. The multivariable-adjusted hazard ratio (95% confidence interval) for the onset of NAFLD in women with a sleep duration <6 hours compared with those with a sleep duration of 7 to <8 hours was 1.55 (1.09-2.20; p=0.02). Conclusions In women, a short sleep duration was independently associated with the onset of NAFLD, thus suggesting that an adequate sleep duration can be a promising preventive factor for the onset of NAFLD in women.

Lifestyle factors affecting new-onset nonalcoholic fatty liver disease

Evidence for the influence of lifestyle factors on nonalcoholic fatty liver disease (NAFLD) onset is limited because the association between lifestyle factors and NAFLD has been reported mostly in cross-sectional studies. Our purpose was to elucidate which lifestyle factors are associated with NAFLD onset by performing a longitudinal study. This was a longitudinal study of 1,713 Japanese participants who underwent multiple health checkups from June 2013 to the end of March 2018 and were not diagnosed with NAFLD at the first health checkup at Watari Hospital in Fukushima, Japan. Baseline characteristics, including lifestyle factors, were compared among participants with and without NAFLD. Cox proportional hazards models were used to identify the association between lifestyle factors and NAFLD onset. Among the 1,713 participants, 420 (24.5 %) developed NAFLD during the observation period (median 47 months). There were significant differences in body mass index and hepatobiliary enzyme levels between participants with and without NAFLD. In Cox proportional hazards models, eating between meals (hazard ratio (HR): 2.08, 95 % confidence interval (CI): 1.25-3.45, p < 0.01) and eating fast (HR: 1.59, 95 % CI: 1.26-2.00, p < 0.01) were risk factors for NAFLD onset in men and women, respectively. Moreover, fast walking was a protective factor against NAFLD onset in women (HR: 0.76, 95 % CI: 0.60-0.96, p = 0.02). These findings could help to identify patients at risk and prevent future NAFLD onset.

Association between equol and non-alcoholic fatty liver disease in Japanese women in their 50s and 60s

BACKGROUND AND AIM

Equol is a metabolite of soy isoflavone and has estrogenic activity. The incidence of non-alcoholic fatty liver disease (NAFLD) increases after menopause in women, which is thought to result in a decrease in estrogen. This study aimed to evaluate the association between equol and NAFLD.

METHODS

We evaluated 1185 women aged 50-69 years who underwent health check-ups at four health centers in Fukushima, Japan. Equol producers were defined by a urinary equol concentration of 1.0 μM or more. In addition to comparison between equol producers and non-producers, the association between equol and NAFLD was estimated using logistic regression analysis adjusting for fast walking and eating habits.

RESULTS

Of the 1185 participants, 345 (29.1%) women were equol producers. The proportions of women who had NAFLD (34.8% vs 45.2%) were significantly lower in the equol-producing group than in the non-producing group. Multivariable logistic regression analysis showed that equol production was significantly associated with NAFLD (odds ratio = 0.66, 95% confidence interval: 0.51-0.86).

CONCLUSIONS

Equol production was significantly associated with NAFLD in women in their 50s and 60s.

Association of equol with obesity in postmenopausal women

OBJECTIVE

Equol, which is an active metabolite of isoflavone, has a beneficial impact on metabolic diseases such as dyslipidemia and hyperglycemia. However, the effect of equol on obesity remains uncertain. This study was performed to determine the association between equol and obesity in postmenopausal women.

METHODS

We evaluated 386 women in their 50s-60s who underwent health check-ups from February 2018 to January 2019 at Watari Hospital Health Center in Fukushima, Japan. Overweight and visceral obesity were defined as a body mass index ≥25 kg/m2 and waist circumference ≥ 90 cm, respectively. Participants were asked to complete a questionnaire about their ordinary lifestyle. Participants were defined as equol producers when urinary equol level was 1.0 μM or more. The proportion of individuals with obesity (overweight and visceral obesity) and lifestyle factors were compared between equol producers and nonproducers. In addition, the association between equol and obesity was examined using logistic regression analysis with adjustment for lifestyle factors.

RESULTS

Of the 386 participants, 106 (27.5%) women were equol producers. The proportions of women who were overweight (13.2% vs 25.7%) and had visceral obesity (6.6% vs 20.7%) were significantly lower in the equol-producing group than in the nonproducing group. Multivariable logistic regression analysis showed that equol production was significantly associated with overweight (odds ratio =0.47, 95% confidence interval: 0.25-0.88) and visceral obesity (odds ratio =0.30, 95% confidence interval: 0.13-0.68).

CONCLUSIONS

Equol is significantly associated with obesity in postmenopausal women.

Effects of sleep quality on non-alcoholic fatty liver disease: a cross-sectional survey

BACKGROUND

The effects of sleep quality on the risk of developing non-alcoholic fatty liver disease (NAFLD) remain uncertain. The purpose of this study was to clarify the association between sleep quality and NAFLD.

METHODS

The data of 4828 participants who underwent health check-ups at four hospitals were analysed. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), which comprised seven elements scored from 0 to 3. The global PSQI score and the score for each element were compared between NAFLD and non-NAFLD groups separately by sex. Logistic regression analysis was performed to determine the association between NAFLD and each PSQI score.

RESULTS

In both men and women, the mean PSQI score for sleep medication use was significantly higher in non-NAFLD than in NAFLD. With regard to sleep medication use in men, the OR (95% CI) for NAFLD was lower with a score of 3 (OR 0.60, 95% CI 0.38-0.95) than with a score of 0 on multivariate logistic regression analysis adjusted for age, smoking habits and physical activity. The OR for NAFLD based on daytime dysfunction was also higher with a score of 3 than with a score of 0 in both men (OR 2.82, 95% CI 1.39-5.75) and women (OR 2.08, 95% CI 1.10-3.92). After adjustment for body mass index, the sleep latency scores in men and daytime dysfunction in women were associated with NAFLD.

CONCLUSION

Sleep quality was associated with NAFLD, and there were sex differences.

Critical Assessment of Myelography Practices: A Call for Rational Guideline Revision

BACKGROUND AND PURPOSE

Patient preparation for myelography and postprocedural monitoring varies widely between practices, despite published guidelines. Our aim was to examine the current practice variations in discontinuing reportedly seizure threshold-lowering medications before myelography and to assess the reported incidence of postmyelographic seizures.

MATERIALS AND METHODS

An e-mail survey was sent to American Society of Neuroradiology members concerning the number of postmyelographic seizures experienced in the past 5 years, the presence of an institutional policy for discontinuing seizure threshold-lowering medications, and the type of myelographic contrast used. We compared the postmyelographic seizure frequency in the responses.

RESULTS

Of 700 survey responses, 57% reported that they do not discontinue seizure threshold-lowering medications before myelography. Most (97%) indicated never having a patient experience a seizure following myelography. The number of postmyelographic seizures between those who discontinue seizure threshold-lowering medications and those who do not was not statistically significant (OR = 2.13; 95% CI, 0.91-4.98; P = .08). Most (95%) reported using nonionic hypo-osmolar agents.

CONCLUSIONS

Survey results revealed widely variable practices for patient myelography preparation and postprocedural monitoring. We found no difference in reported seizures between those who discontinued seizure threshold-lowering medications and those who did not. In light of our findings, we propose that discontinuing reportedly seizure threshold-lowering medications is not warranted with the current nonionic water-soluble contrast agents and may be potentially harmful in some instances. This work supports revision of existing recommendations to withhold such medications before myelography.

Intranasal Esthesioneuroblastoma: CT Patterns Aid in Preventing Routine Nasal Polypectomy

BACKGROUND AND PURPOSE

Esthesioneuroblastoma is a neuroectodermal tumor that commonly arises in the nasal cavity olfactory recess and, when isolated to the intranasal cavity, can be indistinguishable from benign processes. Because lesional aggressiveness requires a more invasive operation for resection than polypectomy, patients with isolated intranasal lesions were studied to define distinguishing CT characteristics.

MATERIALS AND METHODS

Patients with intranasal esthesioneuroblastoma and controls without esthesioneuroblastoma with olfactory recess involvement were identified by using a report search tool. Studies demonstrating skull base invasion and/or intracranial extension were excluded. The imaging spectrum of these lesions was reviewed on both CT and MR imaging, and CT findings were compared with those of controls without esthesioneuroblastoma. Two blinded readers assessed subjects with esthesioneuroblastomas and controls without esthesioneuroblastoma and, using only CT criteria, rated their level of suspicion for esthesioneuroblastoma in each case.

RESULTS

Eight histologically proved cases of intranasal esthesioneuroblastoma were reviewed. All cases had CT demonstrating 3 main findings: 1) an intranasal polypoid lesion with its epicenter in a unilateral olfactory recess, 2) causing asymmetric olfactory recess widening, and 3) extending to the cribriform plate. Twelve patients with non-esthesioneuroblastoma diseases involving the olfactory recess were used as controls. Using these 3 esthesioneuroblastoma CT criteria, 2 blinded readers evaluating patients with esthesioneuroblastoma and controls had good diagnostic accuracy (area under the curve = 0.85 for reader one, 0.81 for reader 2) for predicting esthesioneuroblastoma.

CONCLUSIONS

Esthesioneuroblastoma can present as a well-marginated intranasal lesion that unilaterally widens the olfactory recess. CT patterns can help predict esthesioneuroblastoma, potentially preventing multiple operations by instigating the correct initial operative management.

Optimal Fat Suppression in Head and Neck MRI: Comparison of Multipoint Dixon with 2 Different Fat-Suppression Techniques, Spectral Presaturation and Inversion Recovery, and STIR

BACKGROUND AND PURPOSE

Uniform complete fat suppression is essential for identification and characterization of most head and pathology. Our aim was to compare the multipoint Dixon turbo spin-echo fat-suppression technique with 2 different fat-suppression techniques, including a hybrid spectral presaturation with inversion recovery technique and an inversion recovery STIR technique, in head and neck fat-suppression MR imaging.

MATERIALS AND METHODS

Head and neck MR imaging datasets of 72 consecutive patients were retrospectively reviewed. All patients were divided into 2 groups based on the type of fat-suppression techniques used (group A: STIR and spectral presaturation with inversion recovery gadolinium-T1WI; group B: multipoint Dixon T2 TSE and multipoint Dixon gadolinium-T1WI TSE). Objective and subjective image quality and scan acquisition times were assessed and compared between multipoint Dixon T2 TSE versus STIR and multipoint Dixon gadolinium-T1WI TSE versus spectral presaturation with inversion recovery gadolinium-T1WI using the Mann-Whitney U test.

RESULTS

A total of 64 patients were enrolled in the study (group A, n = 33 and group B, n = 31). Signal intensity ratios were significantly higher for multipoint Dixon T2 and gadolinium-T1WI techniques compared with STIR (P < .001) and spectral presaturation with inversion recovery gadolinium-T1WI (P < .001), respectively. Two independent blinded readers revealed that multipoint Dixon T2 and gadolinium-T1WI techniques had significantly higher overall image quality (P = .022 and P < .001) and fat-suppression grades (P < .013 and P < .001 across 3 different regions) than STIR and spectral presaturation with inversion recovery gadolinium-T1WI, respectively. The scan acquisition time was relatively short for the multipoint Dixon technique (2 minutes versus 4 minutes 56 seconds for the T2-weighted sequence and 2 minutes versus 3 minutes for the gadolinium-T1WI sequence).

CONCLUSIONS

The multipoint Dixon technique offers better image quality and uniform fat suppression at a shorter scan time compared with STIR and spectral presaturation with inversion recovery gadolinium-T1WI techniques.

MR Imaging of the Superior Cervical Ganglion and Inferior Ganglion of the Vagus Nerve: Structures That Can Mimic Pathologic Retropharyngeal Lymph Nodes

BACKGROUND AND PURPOSE

The superior cervical ganglion and inferior ganglion of the vagus nerve can mimic pathologic retropharyngeal lymph nodes. We studied the cross-sectional anatomy of the superior cervical ganglion and inferior ganglion of the vagus nerve to evaluate how they can be differentiated from the retropharyngeal lymph nodes.

MATERIALS AND METHODS

This retrospective study consists of 2 parts. Cohort 1 concerned the signal intensity of routine neck MR imaging with 2D sequences, apparent diffusion coefficient, and contrast enhancement of the superior cervical ganglion compared with lymph nodes with or without metastasis in 30 patients. Cohort 2 used 3D neurography to assess the morphology and spatial relationships of the superior cervical ganglion, inferior ganglion of the vagus nerve, and the retropharyngeal lymph nodes in 50 other patients.

RESULTS

All superior cervical ganglions had homogeneously greater enhancement and lower signal on diffusion-weighted imaging than lymph nodes. Apparent diffusion coefficient values of the superior cervical ganglion (1.80 ± 0.28 × 10^-3mm²/s) were significantly higher than normal and metastatic lymph nodes (0.86 ± 0.10 × 10^-3mm²/s, P < .001, and 0.73 ± 0.10 × 10^-3mm²/s, P < .001). Ten and 13 of 60 superior cervical ganglions were hypointense on T2-weighted images and had hyperintense spots on both T1- and T2-weighted images, respectively. The latter was considered fat tissue. The largest was the superior cervical ganglion, followed in order by the retropharyngeal lymph node and the inferior ganglion of the vagus nerve (P < .001 to P = .004). The highest at vertebral level was the retropharyngeal lymph nodes, followed, in order, by the inferior ganglion of the vagus nerve and the superior cervical ganglion (P < .001 to P = .001). The retropharyngeal lymph node, superior cervical ganglion, and inferior ganglion of the vagus nerve formed a line from anteromedial to posterolateral.

CONCLUSIONS

The superior cervical ganglion and the inferior ganglion of the vagus nerve can be almost always differentiated from retropharyngeal lymph nodes on MR imaging by evaluating the signal, size, and position.

Do Radiologists Report the TNM Staging in Radiology Reports for Head and Neck Cancers? A National Survey Study

BACKGROUND AND PURPOSE

CT and MR imaging are widely used for the staging of head and neck cancer. Currently, there are no data regarding whether the primary tumor, nodes, metastasis (TNM) staging is routinely incorporated into radiology reports. We conducted a national survey to determine whether radiologists routinely address staging, in particular regarding T (primary tumor) and N (nodal).

MATERIALS AND METHODS

The survey was sent to 782 members of the American Society of Head and Neck Radiology. The survey asked whether they assign TN staging in reports. If they do assign TN staging, what are the reasons for doing so, and if not, what are the barriers or reasons for not including it in the radiology report? The method of measuring the size of the primary tumor and pathologic lymph nodes was also queried.

RESULTS

A total of 229 responses were returned (29.3% response rate). Approximately half (49%; 95% confidence interval, 43.55-54.5%) of the responders thought that incorporating TN staging is important. However, only 24.5% (95% confidence interval, 19.8%-29.2%) stated that they routinely assigned TN staging in their radiology reports. The most common barriers were being afraid of being inaccurate (59%) and being unable to remember the staging classifications (58.2%); 76.9% indicated that they measure a primary tumor in 3D.

CONCLUSIONS

Staging head and neck cancer based on imaging presents unique challenges. Nearly half of the responding radiologists think it is important to incorporate TN staging in radiology reports, though only a quarter of them routinely do so in practice.

Dynamic Contrast-Enhanced MR Imaging in Head and Neck Cancer: Techniques and Clinical Applications

In the past decade, dynamic contrast-enhanced MR imaging has had an increasing role in assessing the microvascular characteristics of various tumors, including head and neck cancer. Dynamic contrast-enhanced MR imaging allows noninvasive assessment of permeability and blood flow, both important features of tumor hypoxia, which is a marker for treatment resistance for head and neck cancer. Dynamic contrast-enhanced MR imaging has the potential to identify early locoregional recurrence, differentiate metastatic lymph nodes from normal nodes, and predict tumor response to treatment and treatment monitoring in patients with head and neck cancer. Quantitative analysis is in its early stage and standardization and refinement of technique are essential. In this article, we review the techniques of dynamic contrast-enhanced MR imaging data acquisition, analytic methods, current limitations, and clinical applications in head and neck cancer.

Impact of model-based iterative reconstruction on image quality of contrast-enhanced neck CT

BACKGROUND AND PURPOSE

Improved image quality is clinically desired for contrast-enhanced CT of the neck. We compared 30% adaptive statistical iterative reconstruction and model-based iterative reconstruction algorithms for the assessment of image quality of contrast-enhanced CT of the neck.

MATERIALS AND METHODS

Neck contrast-enhanced CT data from 64 consecutive patients were reconstructed retrospectively by using 30% adaptive statistical iterative reconstruction and model-based iterative reconstruction. Objective image quality was assessed by comparing SNR, contrast-to-noise ratio, and background noise at levels 1 (mandible) and 2 (superior mediastinum). Two independent blinded readers subjectively graded the image quality on a scale of 1-5, (grade 5 = excellent image quality without artifacts and grade 1 = nondiagnostic image quality with significant artifacts). The percentage of agreement and disagreement between the 2 readers was assessed.

RESULTS

Compared with 30% adaptive statistical iterative reconstruction, model-based iterative reconstruction significantly improved the SNR and contrast-to-noise ratio at levels 1 and 2. Model-based iterative reconstruction also decreased background noise at level 1 (P = .016), though there was no difference at level 2 (P = .61). Model-based iterative reconstruction was scored higher than 30% adaptive statistical iterative reconstruction by both reviewers at the nasopharynx (P < .001) and oropharynx (P < .001) and for overall image quality (P < .001) and was scored lower at the vocal cords (P < .001) and sternoclavicular junction (P < .001), due to artifacts related to thyroid shielding that were specific for model-based iterative reconstruction.

CONCLUSIONS

Model-based iterative reconstruction offers improved subjective and objective image quality as evidenced by a higher SNR and contrast-to-noise ratio and lower background noise within the same dataset for contrast-enhanced neck CT. Model-based iterative reconstruction has the potential to reduce the radiation dose while maintaining the image quality, with a minor downside being prominent artifacts related to thyroid shield use on model-based iterative reconstruction.

The Association between Sleep Duration and Non-Alcoholic Fatty Liver Disease among Japanese Men and Women

OBJECTIVE

To examine the relationship between sleep duration and non-alcoholic fatty liver disease (NAFLD).

METHODS

We evaluated 3,968 subjects who underwent health check-ups from June 2012 to May 2013 at the Watari Hospital Health Center in Fukushima Prefecture in Japan. Fatty liver was detected by ultrasonography. Sleep duration and lifestyle factors were estimated using a questionnaire. Sleep duration was categorized into the following groups: ≤ 6, 6 to ≤ 7, >7 to ≤ 8, and >8 h. The four sleep duration groups were compared using the χ(2) test and Kruskal-Wallis test.

RESULTS

In total, 2,172 subjects were enrolled. The overall prevalence of NAFLD was 29.6% (men, 38.0%; women, 25.3%). The proportion of NAFLD tended to decrease as sleep duration increased in men. The proportion with NAFLD was lowest in the group with a sleep duration of 6 to ≤ 7 h and highest in the groups with sleep durations of ≤ 6 and >8 h in women. The distribution showed a U-shaped curve. The age-adjusted odds ratio (OR) (95% confidence interval (CI)) for subjects with NAFLD with a sleep duration ≤ 6 h compared to the reference (6 to ≤ 7 h) was 1.44 (1.06-1.96) in women.

CONCLUSION

Sleep shortage tends to be associated with NAFLD in women and may be mediated by body adiposity.

Imaging evidence and recommendations for traumatic brain injury: advanced neuro- and neurovascular imaging techniques

SUMMARY

Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge.

Staging of laryngeal cancer using 64-channel multidetector row CT: comparison of standard neck CT with dedicated breath-maneuver laryngeal CT

BACKGROUND AND PURPOSE

With a 64-channel multidetector row CT, imaging acquisition during speech, swallowing, or phonation has become feasible. However, the actual benefit of these additional focused images should be critically evaluated with respect to radiation dose. The purpose of this study was to determine if dedicated laryngeal CT using breath-holding and straw-blowing improved the accuracy of TNM-staging for patients with biopsy-proved laryngeal carcinomas in comparison with a standard neck CT.

MATERIALS AND METHODS

A total of 27 patients underwent a standard neck CT and a laryngeal CT with additional images acquired while patients held their breath or blew through a straw. Two radiologists interpreted the neck CT and later the laryngeal CT and assigned a TNM-stage for each case. These interpretations were compared with a TNM-stage determined by surgery and/or clinical examination for the individual patients. The accuracy of standard neck CT was compared with the accuracy of laryngeal CT.

RESULTS

The overall accuracy was not significantly different between standard neck CT and the additional laryngeal CT and was, in fact, lower in cases with additional larynx images. The accuracy of staging was slightly improved with the additional laryngeal CT for glottic cancers; however, it was decreased for supraglottic cancers. The accuracy of a dichotomous diagnosis of early-versus-advanced-stage cancer was 0.86 for the standard neck CT and 0.80 for the laryngeal CT. The readers' confidence levels did not improve with the use of the additional images.

CONCLUSIONS

In the era of isovoxel multidetector CT technology and judicious monitoring of radiation dose, a standard neck CT with coronal and sagittal reformats should suffice for the staging of laryngeal cancer.

Balancing radiation dose and image quality: clinical applications of neck volume CT

BACKGROUND AND PURPOSE

The advancement of multidetector CT technology has resulted in improved image quality as well as an increase in ionizing radiation dose to patient. The purpose of this study was to assess radiation dose and overall image quality of CT examination of the neck between fixed-tube current and automatic tube current modulation (ATCM) at 2 separate noise index levels.

MATERIALS AND METHODS

A total of 84 patients underwent neck CT with use of a 64-section multidetector row CT (MDCT) scanner. Patients were divided into 3 groups: fixed-tube current (n = 28), ATCM with a noise index of 11.4 (n = 28), and ATCM with a noise index of 20.2 (n = 28). All other scan parameters remained constant. Scan coverage length and transclavicular distance were measured. Two radiologists blinded to the scanning parameters assessed overall image quality, noise level, and streak artifacts using a 5-point grading scale. The radiation dose in dose-length product (DLP) and CT dose index (CTDI) was recorded.

RESULTS

Compared with a fixed-tube current technique, ATCM with a noise index of 11.4 reduced CTDI by 20% (P < .01 x 10(-6)), and ATCM with a noise index of 20.2 reduced CTDI by 34% (P < .01 x 10(-12)). Although the difference in image quality between the fixed-tube current technique and the noise index reached statistical significance (P < .05), the magnitude of the difference was small, with average scores of 3.79 (+/-0.59) and 3.57 (+/-0.53), respectively.

CONCLUSION

Compared with the fixed-tube current technique, ATCM resulted in significant reduction of radiation dose without substantially reducing the image quality of the CT of the neck. Judicious monitoring of radiation dose to patients has to be balanced with diagnostic image quality.

In vivo manganese MR imaging of calcium influx in spontaneous rat pituitary adenoma

BACKGROUND AND PURPOSE

Rapid uptake of the calcium analog manganese (Mn2+) into spontaneous pituitary adenoma during MR imaging of aged rats generated the hypothesis that neuroendocrine tumors may have a corresponding increase in calcium influx required to trigger hormonal release. A goal of this study was to investigate the potential for clinical evaluation of pituitary adenoma by MR imaging combined with administration of Mn2+ (Mn-MR imaging).

MATERIALS AND METHODS

Mn-MR imaging was used to characterize the dynamic calcium influx in normal aged rat pituitary gland as well as spontaneous pituitary adenoma. To confirm the validity of Mn2+ as a calcium analog, we inhibited Mn2+ uptake into the olfactory bulb and pituitary gland of normal rats by using the calcium channel blocker verapamil. Rats with adenomas received fluorodeoxyglucose-positron-emission tomography (FDG-PET) scanning for characterization of tumor metabolism. Mn2+ influx was characterized in cultured pituitary adenoma cells.

RESULTS

Volume of interest analysis of the normal aged pituitary gland versus adenoma indicated faster and increased calcium influx in adenoma at 1, 3, 11, and 48 hours. Mn2+ uptake into the olfactory bulb and pituitary gland of normal rats was inhibited by calcium channel blockers and showed dose-dependent inhibition on dynamic MR imaging. FDG-PET indicated correlation between tumor energy metabolism and Mn2+ influx as well as tumor size.

CONCLUSION

These results indicate that adenomas have increased activity-dependent calcium influx compared with normal aged pituitary glands, suggesting a potential for exploitation in the clinical work-up of pituitary and other neuroendocrine tumors by developing Mn-MR imaging for humans.

Efficiency of transfection and localization of superparamagnetic iron oxide particles in neural progenitor cells using two methods

Stem cells represent a potentially revolutionary therapy for neurological pathologies but for which a thorough investigation of cell behavior in the living nervous system has yet to be performed. Contrast-enhanced cell tracking with magnetic resonance imaging can enable this investigation by introducing superparagmagnetic iron oxide (SPIO) particles within the cell membrane. Before magnetically labeled cells can be observed in vivo, it is essential to maximize SPIO transfer into the cell and to fully understand the localization of the contrast agent in mature neural cells. For practical applications, a quantitative evaluation of labeled cells before implantation will allow in vivo assertions. In this study, we present a comparison between two methods for magnetic transfection of neural progenitor cells: the hemmaglutinating virus of Japan envelope (HVJ-E) as a viral vector and a liposomal reagent. We show that HVJ-E is a more efficient vehicle of cell transfection using quantitative evaluation and that the iron content per cell can be predicted using a simple, automated image analysis of stained, labeled cells. Image analysis is also used in this study to show that the contrast agent is distributed in the axon after differentiation, an important aspect of understanding cell tracking in vivo.

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.