Three-dimensional analysis of perineural invasion in extrahepatic cholangiocarcinoma using tissue clearing

Perineural invasion (PNI) is a characteristic invasion pattern of distal cholangiocarcinoma (DCC). Conventional histopathologic examination is a challenging approach to analyze the spatial relationship between cancer and neural tissue in full-thickness bile duct specimens. Therefore, we used a tissue clearing method to examine PNI in DCC with three-dimensional (3D) structural analysis. The immunolabeling-enabled 3D imaging of solvent-cleared organs method was performed to examine 20 DCC specimens from five patients and 8 non-neoplastic bile duct specimens from two controls. The bile duct epithelium and neural tissue were labeled with CK19 and S100 antibodies, respectively. Two-dimensional hematoxylin/eosin staining revealed only PNI around thick nerve fibers in the deep layer of the bile duct, whereas PNI was not identified in the superficial layer. 3D analysis revealed that the parts of DCC closer to the mucosa exhibited more nerves than the normal bile duct. The nerve fibers were continuously branched and connected with thick nerve fibers in the deep layer of the bile duct. DCC formed a tubular structure invading from the epithelium and extending around thin nerve fibers in the superficial layer. DCC exhibited continuous infiltration around the thick nerve fibers in the deep layer. This is the first study using a tissue clearing method to examine the PNI of DCC, providing new insights into the underlying mechanisms.

Use of time‑density curves of dynamic contrast‑enhanced computed tomography for determination of the histological therapeutic effects of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma

The present study aimed to investigate the histological changes caused by neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC), and to demonstrate the use of time‑density curves (TDCs) of dynamic contrast‑enhanced computed tomography (CECT) for determination of the histological therapeutic effects of NAC for PDAC. A total of 96 patients with PDAC were examined; 46 underwent NAC (NAC group) and 50 did not undergo NAC (non‑NAC group). Based on histological therapeutic effect and using the area of residual tumor (ART) grading system, the NAC group was divided into low‑responders and high‑responders. Histological analysis was used to evaluate the densities of cancer cells, cancer‑associated fibroblasts (CAFs), microvessels and stromal collagen fibers in the NAC and non‑NAC groups. Radiological analysis was used to evaluate the TDCs of three slopes of the NAC group, namely slopes between the non‑contrast and arterial phases (δ1 and δ1'), between the arterial and portal phases (δ2 and δ2'), and between the portal and equilibrium phases (δ3 and δ3'). δ1‑δ3 were before NAC, whereas δ1'‑δ3' were after NAC. Changes in δ1, δ2 and δ3 before and after NAC were denoted as δδ1 (=δ1'‑δ1), δδ2 (=δ2'‑δ2) and δδ3 (=δ3'‑δ3). ART grading system, histological examination and radiological examination data were also statistically analyzed. Histological examination revealed a significant decrease in cancer cells and CAFs, and a significant increase in stromal collagen fibers due to NAC (P<0.01). Radiological examination revealed that δ1' was significantly higher than δ1 in low‑responders (P<0.05), whereas δ2' was significantly lower than δ2 in high‑responders (P<0.01). δδ2 was significantly lower and δδ3 was significantly higher in high‑responders than in low‑responders (P<0.01 and P<0.05, respectively). Receiver operating characteristic curve showed that δδ2 and δδ3 were effective indicators of the histological therapeutic effect of NAC. In conclusion, the TDC of dynamic CECT may be useful for determining the histological therapeutic effect of NAC for PDAC.

The KANNO blood group system

The KANNO blood group system (International Society of Blood Transfusion [ISBT] 037) includes one high-prevalence antigen, KANNO1, across ethnic groups. Sporadic KANNO1- cases among East and South Asians are theoretically estimated by the DNA database library. Anti-KANNO1 has been found most often among Japanese women with current or prior pregnancy. Thus far, there are no reported cases of hemolytic transfusion reaction or hemolytic disease of the fetus and newborn due to anti-KANNO1.

Assessment of Heating on Titanium Alloy Cerebral Aneurysm Clips during 7T MRI

BACKGROUND AND PURPOSE

Patients with cerebral aneurysms often undergo MR imaging after microsurgical clipping. Ultra-high-field MR imaging at 7T may provide high diagnostic capability in such clinical situations. However, titanium alloy clips have safety issues such as adverse interactions with static magnetic fields and radiofrequency-induced heating during 7T MR imaging. The purpose of this study was to quantitatively assess temperature increases on various types of titanium alloy aneurysm clips during 7T MR imaging.

MATERIALS AND METHODS

Five types of titanium alloy aneurysm clips were tested, including combinations of short, long, straight, angled, and fenestrated types. Each clip was set in a phantom filled with gelled saline mixed with polyacrylic acid and underwent 7T MR imaging with 3D T1WI with a spoiled gradient recalled acquisition in the steady-state technique. Temperature was chronologically measured at the tips of the clip blade and head, angled part of the clip, and 5 mm from the tip of the clip head using MR imaging-compatible fiber-optic thermometers.

RESULTS

Temperature increases at all locations for right-angled and short straight clips were <1°C. Temperature increases at the angled part for the 45° angled clip and the tip of the clip head for the straight fenestrated clip were >1°C. Temperature increases at all locations for the long straight clip were >2°C.

CONCLUSIONS

Temperature increases on the right-angled and short straight clips remained below the regulatory limit during 7T MR imaging, but temperature increases on the 45° angled, straight fenestrated, and long straight clips exceeded this limit.

[Treatment for Laterally Invasive Rectal Cancer with Robot-Assisted Surgery after Preoperative Treatment]

The patient is a 40-year-old male. He was referred to our department because, after a thorough examination, he was diagnosed with rectal cancer. Preoperative imaging showed a tumor in the rectum at the level of the seminal vesicles, and left lateral invasion was suspected. In addition, lymph node metastases in the left lateral area were suspected. We performed a robot-assisted low anterior resection plus bilateral lateral dissection plus covering ileostomy for this patient after neoadjuvant chemotherapy. The operation time was 495 minutes, and the blood loss was 50 g. The histopathological diagnosis was pT3, N3(#263), M0, pStage Ⅲc, PM0, DM0, RM0, R0, Cur A. In Japan, robotic-assisted surgery for rectal cancer has been covered by insurance since April 2018, and in our department, robotic surgery is the first option for any stage or type of surgery for rectal cancer. We believe that the greatest advantages of robotic surgery for rectal cancer are in lateral dissection, ie, the better understanding of how blood vessels and nerves travel around the internal iliac vessels and the associated anatomy of pelvic organs that comes from reliable lateral dissection. We have experienced a case of safe robotic-assisted radical resection of laterally invasive rectal cancer, which is considered to be relatively difficult, and we hereby report the usefulness of the robotic-assisted modality.

Probing the Magnetosheath Boundaries Using Interstellar Boundary Explorer (IBEX) Orbital Encounters

Inside the magnetosheath, the IBEX-Hi energetic neutral atom (ENA) imager measures a distinct background count rate that is more than 10 times the typical heliospheric ENA emissions observed when IBEX is outside the magnetosheath. The source of this enhancement is magnetosheath ions of solar wind (SW) origin that deflect around the Earth's magnetopause (MP), scatter and neutralize from the anti-sunward part of the IBEX-Hi sunshade, and continue into the instrument as neutral atoms, behaving indistinguishably from ENAs emitted from distant plasma sources. While this background pollutes observations of outer heliospheric ENAs, it provides a clear signature of IBEX crossings over the magnetospheric boundaries. In this study, we investigate IBEX encounters with the magnetosheath boundaries using ∼8 yr of orbital data, and we determine the MP and bow shock (BS) locations derived from this background signal. We find 280 BS crossings from X _GSE ∼ 11 R_e to X _GSE ∼ -36 R_e and 241 MP crossings from X _GSE ∼ 6 R_e to X _GSE ∼ -48 R_e. We compare IBEX BS and MP crossing locations to those from IMP-8, Geotail, Cluster, Magion-4, ISEE, and Magnetospheric Multiscale Mission, and we find that IBEX crossing locations overlap with the BS and MP locations inferred from these other data sets. In this paper, we demonstrate how IBEX can be used to identify magnetosheath crossings, and extend boundary observations well past the terminator, thus further constraining future models of magnetosheath boundaries. Furthermore, we use the IBEX data set to show observational evidence of near-Earth magnetotail squeezing during periods of strong interplanetary magnetic field B _y.

[Intrathoracic Migration of a Kirschner Wire Successfully Removed by Video-assisted Thoracic Surgery:Report of a Case]

A 40-year-old man who had been surgically treated for the fracture of the right humerus with two Kirschner wires (K-wires) complained of chest pain and difficulty in breathing at fourth day after surgery and visited our hospital. Chest radiography revealed dislocation of the K-wire and right pneumothorax. Video-assisted thoracic surgery( VATS) was performed immediately, and the K-wire was removed safely.

AB0045 THE RELATIONSHIP BETWEEN CD14 AND VIMENTIN-POSITIVE SYNOVIAL DENDRITIC-SHAPED CELLS AND SYNOVITIS IN RHEUMATOID ARTHRITIS

Background:

Inflammation in rheumatoid arthritis (RA) is caused by multiple cell types, including infiltrating inflammatory cells, such as lymphocytes, neutrophils, macrophages, and spindle-shaped fibroblasts. Especially, we are focusing on fibroblast-like synoviocytes (FLSs). In our previous study, we have reported that FLSs were positive for multiple markers including CD14, CD68 and HLA-DR, and were dendritic-shaped cells constituting nursing phenomenon between lymph or plasma cells. In addition, in our recent study, we found that CD14+FLSs were positive for vimentin (VIM), which is a marker for mesenchymal cells. There are still many issues to be discussed regarding CD14+VIM+ cells.

Objectives:

To investigate the relationship between CD14+VIM+ cells and the degree of synovitis in rheumatoid arthritis.

Methods:

Synovial tissues collected from RA patients who underwent joint surgeries were prepared for this study. First, the proportions of CD14+ cells in RA synovial tissue and control were analyzed using flow cytometry and the concentrations of inflammatory cytokines released by CD14+ cells in RA synovial tissue and control were examined by ELISA. Next, the proportions of CD14+VIM+ cells in RA synovial tissue and control were examined immunohistologically and then we analyzed the results using image analysis software. Also, we statistically analyzed the relationship between the proportion of CD14+VIM+ cells, the degree of synovitis, and clinical data.

Results:

Results of flow cytometry showed that CD14+ cells were frequently observed in RA synovial tissue than control. Cultured CD14+ cells released more inflammatory cytokines than cultured CD14- cells. Also, results of immunohistological staining showed that many CD14+VIM+ cells were observed in RA synovial tissue than in control. The proportion of CD14+VIM+ cells was correlated with Krenn synovitis score. High proportion cases significantly showed high level of CRP and MMP-3.

Conclusion:

CD14+VIM+ cells might be involved in the mechanism of chronic immunological inflammation in RA and the proportion of these cells might influence the clinical data.

References:

[1]Ochi T, Yoshikawa H, Toyosaki-Maeda T, Lipsky PE. Mesenchymal stromal cells. Nurse-like cells reside in thesynovial tissue and bone marrow in rheumatoid arthritis. Arthritis Research&Therapy 2007; 9(1): 201.

[2]Ochi T, Sawai T, Murakami K, Kamataki A, Uzuki M, Tomita T, et al. Nurse-like cells in rheumatoid arthritis: Formation of survival niches cooperating between the cell types. Mod Rheum 2018; 29: 1-5.

[3]Krenn V, Morawietz L, Burmester GR, Kinne RW, Muller-Ladner U, Muller B, Haupl T. Synovitis score: discrimination between chronic low-grade and high-grade synovitis. Histopathology 2006; 49: 358-64.

Disclosure of Interests:

None declared

Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease

BACKGROUND AND PURPOSE

Adult patients with ischemic Moyamoya disease are advised to undergo selective revascularization surgery based on cerebral hemodynamics. The purpose of this study was to determine the diagnostic accuracy of arterial spin-labeling MR imaging using Hadamard-encoded multiple postlabeling delays for the detection of reduced CBF in such patients.

MATERIALS AND METHODS

Thirty-seven patients underwent brain perfusion SPECT and pseudocontinuous arterial spin-labeling MR imaging using standard postlabeling delay (1525 ms) and Hadamard-encoded multiple postlabeling delays. For Hadamard-encoded multiple postlabeling delays, based on data obtained from the 7 sub-boluses with combinations of different labeling durations and postlabeling delays, CBF corrected by the arterial transit time was calculated on a voxel-by-voxel basis. Using a 3D stereotaxic template, we automatically placed ROIs in the ipsilateral cerebellar hemisphere and 5 MCA territories in the symptomatic cerebral hemisphere; then, the ratio of the MCA to cerebellar ROI was calculated.

RESULTS

The area under the receiver operating characteristic curve for detecting reduced SPECT-CBF ratios (<0.686) was significantly greater for the Hadamard-encoded multiple postlabeling delays-CBF ratios (0.885) than for the standard postlabeling delay-CBF ratios (0.786) (P = .001). The sensitivity and negative predictive value for the Hadamard-encoded multiple postlabeling delays-CBF ratios were 100% (95% confidence interval, 100%-100%) and significantly higher than the sensitivity (95% CI, 44%-80%) and negative predictive value (95% CI, 88%-97%) for the standard postlabeling delay-CBF ratio, respectively.

CONCLUSIONS

ASL MR imaging using Hadamard-encoded multiple postlabeling delays may be applicable as a screening tool because it can detect reduced CBF on brain perfusion SPECT with 100% sensitivity and a 100% negative predictive value in adult patients with ischemic Moyamoya disease.

Serum cytokine profiling in neonates with hypoxic ischemic encephalopathy

BACKGROUND

The fetal brain is vulnerable to severe and sustained hypoxia during and after birth, which can lead to hypoxic-ischemic encephalopathy (HIE). HIE is characterized by clinical and laboratory evidence of acute or subacute brain injury. The role of cytokines in the pathogenesis of brain injury and their relation to neurological outcomes of asphyxiated neonates are not fully understood. In this study, we investigated cytokine profile related to cerebral palsy (CP) with neonatal hypoxic ischemic encephalopathy (HIE) and HIE severity.

METHODS

Eligible subjects were HIE newborns with a gestational age between 36 and 42 weeks. We included newborns who was born at our NICU and did not admit to NICU as healthy controls. The study comprised 52 newborns, including 13 with mild to severe HIE and 39 healthy control. Serum cytokine profiles were performed using a LUMINEX cytokine kit (R&D Systems).

RESULTS

VEGF, MCP-1, IL-15, IL-12p70, IL-12p40, IL-1Ra, IL-2, IL-6, IL-7, IL-8, IL-10, IFN-γ, G-CSF and eotaxin in the HIE patients were significantly increased compared with the healthy neonates. In the subgroup analysis, IL-6 and G-CSF were significantly increased in CP infants (n = 5) compared with non-CP infants (n = 8). Five and eight HIE patients were classified into the mild HIE and moderate-severe HIE groups, respectively. IL-6, 10, 1Ra, and G-CSF in the moderate-severe HIE group were significantly higher than those in the mild HIE group.

CONCLUSION

We demonstrated that higher serum IL-6 and G-CSF at birth in HIE patients were associated with CP and moderate-severe HIE.

[Short-Term Results of Robot-Assisted Surgery in Patients Undergoing Neoadjuvant Chemotherapy for Rectal Cancer]

The advantages of robot-assisted surgery include: stable deployment of the robotic arm that enables excellent radical cure characteristics and preservation of function; the ability to perform precise surgery even in patients in whom performing laparoscopic surgery is difficult, such as those with pelvic or bulky tumors. However, there have been some reports on such issues as an increase in the incidence of postoperative complications and an increase in postoperative hospital stay in patients who underwent neoadjuvant chemotherapy(NAC); thus, we summarized and are reporting the short-term results of our experience in patients seen in our department to date. A total of 76 patients with rectal cancer who underwent robot-assisted surgery, and short-term postoperative results were compared between patients who underwent neoadjuvant chemotherapy (NAC group)and those who did not undergo neoadjuvant chemotherapy(non-NAC group). Of the 76 patients, 59 (77.6%)were male and 17(22.4%)were female, and 27(35.5%)in the NAC group. In the comparisons between the NAC and non-NAC groups, although the difference in operative time(523.5 vs 317.5 minutes, p<0.01)was significant, there were no significant differences in any of blood loss(59 vs 20g, p=0.22), postoperative hospital stay(14 vs 13 days: p=0.07), and onset of complications that were Clavien-Dindo Grade Ⅲa or higher(2 vs 1 patients, p=0.82). Robot- assisted surgery after NAC for rectal cancer was considered to be safe and very useful.

[A Case of Pancreatotomy of the Pancreatic Tail with a Preserved Residual Stomach Using ICG Fluorescence Method for Pancreatic Cancer after Gastrectomy of the Pyloric Side]

A 53-year-old male had a history of gastrectomy of the pyloric side for gastric cancer and Billroth Ⅰ reconstruction done 20 years ago. The patient visited the gastrointestinal internal medical department of our hospital with abdominal pain as the chief complaint. Pancreatic cancer was diagnosed with the help of an abdominal CT, and he was then referred to our department. The preoperative disease stage was cT3, N0, M0, Stage ⅡA. As it was over 20 years since the previous surgery and the preoperative CT showed cardiac branches of the left inferior phrenic artery, we inferred that the residual stomach can be preserved. The blood flow was confirmed by the intraoperative ICG fluorescence method, and we then performed pancreatotomy of the pancreatic tail, preserving the stomach and a splenectomy. The pathologic findings were invasive ductal carcinoma, pT3, N1a, M0, Stage ⅡB, and R0. S-1 was administered orally as postoperative adjunctive chemotherapy. The postoperative course has been favorable without recurrence for 2 years. In case a pancreatotomy of the pancreatic tail is performed for cancer of the pancreatic body after gastrectomy of the pyloric side, it was considered that the intraoperative ICG fluorescence method was useful to confirm the blood flow of the residual stomach.

Transient ischemic attack without self-awareness of symptoms witnessed by bystanders: analysis of the PROMISE-TIA registry

Background and purpose

A transient ischemic attack (TIA) can occur without self‐awareness of symptoms. We aimed to investigate characteristics of patients with a tissue‐based diagnosis of TIA but having no self‐awareness of their symptoms and whose symptoms were witnessed by bystanders.

Methods

We used data from the multicenter registry of 1414 patients with a clinical diagnosis of TIA. For patients without evidence of ischemic lesions on imaging, clinical characteristics were compared between patients with and without self‐awareness of their TIA symptoms.

Results

Among 896 patients (559 men, median age of 70 years), 59 (6.6%) were unaware of their TIA symptoms, but had those symptoms witnessed by bystanders. Patients without self‐awareness of symptoms were older and more frequently female, and more likely to have previous history of stroke, premorbid disability, and atrial fibrillation, but less likely to have dyslipidemia than those with self‐awareness. Patients without self‐awareness of symptoms arrive at hospitals earlier than those with self‐awareness (P < 0.001). ABCD² score was higher in patients without self‐awareness of symptoms than those with self‐awareness (median 5 vs. 4, P = 0.002). Having no self‐awareness of symptoms was a significant predictor of ischemic stroke within 1 year after adjustment for sex, ABCD² score, and onset to arrival time (hazard ratio = 2.44, 95% confidential interval: 1.10–4.83), but was not significant after further adjustment for arterial stenosis or occlusion.

Conclusions

Patients with a TIA but having no self‐awareness of their symptoms might have higher risk of subsequent ischemic stroke rather than those with self‐awareness, suggesting urgent management is needed even if patients have no self‐awareness of symptoms.

First Global Images of Ion Energization in the Terrestrial Foreshock by the Interstellar Boundary Explorer

The Interstellar Boundary Explorer (IBEX) mission provides global energetic neutral atom (ENA) observations from the heliosphere and the Earth's magnetosphere, including spatial, temporal, and energy information. IBEX views the magnetosphere from the sides and almost always perpendicular to noon-midnight plane. We report the first ENA images of the energization process in the Earth's ion foreshock and magnetosheath regions. We show ENA flux and spectral images of the dayside magnetosphere with significant energization of ENA plasma sources (above ~2.7 keV) in the region magnetically connected to the Earth's bow shock (BS) in its quasi-parallel configuration of the interplanetary magnetic field (IMF). We also show that the ion energization increases gradually with decreasing IMF-BS angle, suggesting more efficient suprathermal ion acceleration deeper in the quasi-parallel foreshock.

Acetazolamide-Loaded Dynamic 7T MR Quantitative Susceptibility Mapping in Major Cerebral Artery Steno-Occlusive Disease: Comparison with PET

BACKGROUND AND PURPOSE

Dynamic changes in cerebrovascular reactivity after acetazolamide administration vary markedly among patients with major cerebral arterial steno-occlusive disease. MR quantitative susceptibility mapping can dynamically quantify the cerebral magnetic susceptibility. The purpose of this study was to determine whether dynamic changes in susceptibility after administration of acetazolamide on 7T quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in the cerebral hemispheres with major cerebral arterial steno-occlusive disease.

MATERIALS AND METHODS

Sixty-five patients underwent 7T MR imaging at baseline and at 5, 10, 15, and 20 minutes after acetazolamide administration. Differences between the susceptibility of venous structures and surrounding brain tissue were calculated in the quantitative susceptibility mapping images. Susceptibility differences at 5, 10, 15, and 20 minutes after acetazolamide administration relative to baseline were calculated in 97 cerebral hemispheres with major cerebral arterial steno-occlusive disease. CBV and the cerebral metabolic rate of oxygen were also calculated using ¹⁵O-gas PET in the resting state.

RESULTS

Dynamic changes of susceptibility after acetazolamide administration were classified into 3 patterns: abnormally increasing 5 or 10 minutes after acetazolamide administration; abnormally decreasing within 20 minutes after acetazolamide administration; and remaining unchanged after acetazolamide administration. CBV was significantly greater in the first pattern than in the latter 2. The cerebral metabolic rate of oxygen differed significantly in descending order from the first to middle to last pattern.

CONCLUSIONS

Dynamic changes of susceptibility after acetazolamide administration on 7T MR quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in major cerebral arterial steno-occlusive disease.

Serum cytokine concentrations, chorioamnionitis and the onset of bronchopulmonary dysplasia in premature infants

OBJECTIVE

To investigate the relationships between serum cytokine concentrations and chorioamnionitis (CAM) and CAM-related bronchopulmonary dysplasia (BPD) in premature infants.

METHODS

Serum was collected at 0 and 7 days after birth from 36 premature infants born at <32 weeks of gestation. We examined the relationships between 30 cytokine concentrations and CAM, BPD, and other perinatal factors.

RESULTS

On day 0, GM-CSF, IL-15, IL-17, IL-2, IL-2R, VEGF, and MIG concentrations were significantly higher in the CAM group (n = 17) than in the non-CAM group (n = 19). These concentrations had decreased by day 7 and were similar in both groups. The IL-12p70 concentration on day 0 was significantly lower in the BPD group (n = 16) than in the non-BPD group (n = 15). BPD incidence was similar between the CAM and non-CAM groups.

CONCLUSIONS

These data support the hypothesis that intrauterine inflammation is not a primary risk factor for BPD. The immunological environment at birth or soon after, rather than intrauterine fetal inflammation (e.g., CAM), is a primary risk factor for BPD onset in preterm infants. Decreased inflammatory responses are particularly relevant, as indicated by the relationship between BPD and low serum IL-12p70 concentrations on day 0.

The B allele with a 5·8 kb deletion in intron 1 of the ABO gene is the major allele in Japanese individuals with Bm and A1 Bm phenotypes

B_m and A₁ B_m phenotypes are the most frequent ABO variants in the Japanese population. The B antigen on B_m red blood cells is only detectable by adsorption and elution tests, and plasma B-transferase activity is usually detected at half or less levels compared with that of common B. Recently, a B allele lacking an erythroid cell-specific transcription enhancer in intron 1 of the ABO gene was identified from individuals with B_m and A₁ B_m phenotypes, which could explain the unique serologic properties of B_m . In the Japanese Red Cross Society, eight Blood Centers tested blood samples from donors throughout Japan and collected blood samples from 888 B_m and 415 A₁ B_m individuals. DNA analysis revealed that 1300 of 1303 (99·77%) individuals had the B allele with a 5·8 kb deletion (c.28 + 5110_10889del), which included the enhancer element.

Comparison of Computer-based Information Support to Clinical Research in Chinese and Japanese Hospitals

Objectives: The objectives of this research are to examine the current situation of computer-based information support of clinical research in hospitals and to determine the expectations of clinicians toward clinical research support functions of hospital information systems (HISs) in both China and Japan.

Methods: 172 clinicians from 42 major hospitals in China (2 groups), and 568 clinicians from 79 university hospitals in Japan (2 groups), were surveyed by postal questionnaire during July and August, 1999. The Kruskal-Wallis test was performed to analyze the differences among the groups.

Results: The total response rate was 66.9%. The result shows that 94.8% of the Japanese clinicians, 3.5 times more than those in China, use computers almost every day. High significance was shown for the frequency of non-HIS based information resources used by clinicians between China and Japan (p <0.001), whereas no significance for the frequency of HIS use by clinicians between the China I and Japan I groups (p = 0.725) was found. 33.3% clinicians in China thought they could obtain 30-50% of the necessary patient data for clinical research from the HIS, about 2 times more than in Japan (p = 0.009).

Conclusions: Although the degree of computer involvement among clinicians in Japan is much higher than in China, the computer-based hospital information systems have not been developed well for supporting clinical research in both countries. The clinicians expect comprehensive computerized patient records (CPRs) and full use of patient related information in the existing HISs to support their clinical research.

Development of a Medical-text Parsing Algorithm Based on Character Adjacent Probability Distribution for Japanese Radiology Reports

Objectives: The objectives of this study were to investigate the transitional probability distribution of medical term boundaries between characters and to develop a parsing algorithm specifically for medical texts.

Methods: Medical terms in Japanese computed tomography (CT) reports were identified using the ChaSen morphological analysis system. MeSH-based medical terms (51,385 entries), obtained from the metathesaurus in the Unified Medical Language System (UMLS, 2005AA), were added as a medical dictionary for ChaSen. A radiographer corrected the set of results containing 300 parsed CT reports. In addition, two radiologists checked the medical term parsing of 200 CT sentences.

Results: We obtained modified inter-annotator agreement scores for the text corrected by the radiologists. We retrieved the transitional probability as the conditional probability of a uni-gram, bi-gram, and tri-gram. The highest transitional probability P(Ci | Ci - 2*Ci - 1) was 1.00. For an example of anatomical location, the term “pulmonary hilum” was parsed as a tri-gram.

Conclusions: Retrieval of transitional probability will improve the accuracy of parsing compound medical terms.

Silent KEL alleles identified from Japanese individuals with the Ko phenotype

BACKGROUND AND OBJECTIVE

The rare K_o phenotype lacks all 36 antigens in the Kell blood system. The molecular basis of the K_o phenotype has been investigated, and more than 40 silent KEL alleles are reported by many investigators. The majority of silent alleles are the KEL*02 background. Here, we report molecular genetic analysis of the KEL gene in Japanese individuals with the K_o phenotype.

MATERIALS AND METHODS

The K_o phenotype was screened from Japanese blood donors for several years using monoclonal anti-Ku or anti-K14 by an automated blood grouping system PK7300. Kell-related antigens were typed by standard tube tests. Genomic DNA was extracted from the blood samples, and KEL gene was analysed by polymerase chain reaction (PCR) and Sanger sequencing.

RESULTS

We collected 35 K_o blood samples with K-k-, Kp(a-b-), Js(a-b-) and K14-. PCR and sequence analysis revealed that 11 individuals were homozygous for a mutant KEL allele with a c.299G>C (p.Cys100Ser) mutation (rs. 200268316). Three individuals were homozygous for the KEL*02N.24 allele that is c.715G>T (p.Glu239*), and one individual was homozygous for the KEL*02N.40 allele that is c.1474C>T (p.Arg492*). Five individuals were homozygous for novel KEL alleles with single-nucleotide mutations, four individuals had a c.2175delC (p.Pro725 fs*43), and one individual had a c.328delA (p.Arg110 fs*79). The remaining 15 individuals were compound heterozygous, and eight new alleles were identified from them.

CONCLUSIONS

We identified three known and ten new silent KEL alleles from Japanese individuals with the K_o phenotype. The KEL allele with the c.299G>C (p.Cys100Ser) mutation was the most frequent.

Preoperative Cerebral Oxygen Extraction Fraction Imaging Generated from 7T MR Quantitative Susceptibility Mapping Predicts Development of Cerebral Hyperperfusion following Carotid Endarterectomy

BACKGROUND AND PURPOSE

Preoperative hemodynamic impairment in the affected cerebral hemisphere is associated with the development of cerebral hyperperfusion following carotid endarterectomy. Cerebral oxygen extraction fraction images generated from 7T MR quantitative susceptibility mapping correlate with oxygen extraction fraction images on positron-emission tomography. The present study aimed to determine whether preoperative oxygen extraction fraction imaging generated from 7T MR quantitative susceptibility mapping could identify patients at risk for cerebral hyperperfusion following carotid endarterectomy.

MATERIALS AND METHODS

Seventy-seven patients with unilateral internal carotid artery stenosis (≥70%) underwent preoperative 3D T2*-weighted imaging using a multiple dipole-inversion algorithm with a 7T MR imager. Quantitative susceptibility mapping images were then obtained, and oxygen extraction fraction maps were generated. Quantitative brain perfusion single-photon emission CT was also performed before and immediately after carotid endarterectomy. ROIs were automatically placed in the bilateral middle cerebral artery territories in all images using a 3D stereotactic ROI template, and affected-to-contralateral ratios in the ROIs were calculated on quantitative susceptibility mapping-oxygen extraction fraction images.

RESULTS

Ten patients (13%) showed post-carotid endarterectomy hyperperfusion (cerebral blood flow increases of ≥100% compared with preoperative values in the ROIs on brain perfusion SPECT). Multivariate analysis showed that a high quantitative susceptibility mapping-oxygen extraction fraction ratio was significantly associated with the development of post-carotid endarterectomy hyperperfusion (95% confidence interval, 33.5-249.7; P = .002). Sensitivity, specificity, and positive- and negative-predictive values of the quantitative susceptibility mapping-oxygen extraction fraction ratio for the prediction of the development of post-carotid endarterectomy hyperperfusion were 90%, 84%, 45%, and 98%, respectively.

CONCLUSIONS

Preoperative oxygen extraction fraction imaging generated from 7T MR quantitative susceptibility mapping identifies patients at risk for cerebral hyperperfusion following carotid endarterectomy.

Cytotoxicity of Natural Killer Cells Activated Through NKG2D Contributes to the Development of Bronchiolitis Obliterans in a Murine Heterotopic Tracheal Transplant Model

Bronchiolitis obliterans after lung transplantation is a major cause of postoperative mortality in which T cell-mediated immunity is known to play an important role. However, the exact contribution of natural killer (NK) cells, which have functions similar to CD8⁺ T cells, has not been defined. Here, we assessed the role of NK cells in murine bronchiolitis obliterans through heterotopic tracheal transplantations and found a greater percentage of NK cells in allografts than in isografts. Depletion of NK cells using an anti-NK1.1 antibody attenuated bronchiolitis obliterans in transplant recipients compared with controls. In terms of NK cell effector functions, an improvement in bronchiolitis obliterans was observed in perforin-KO recipient mice compared to wild type (WT). Furthermore, we found upregulation of NKG2D-ligand in allografts and demonstrated the significance of this using grafts expressing Rae-1, a murine NKG2D-ligand, which induced severe bronchiolitis obliterans in WT and Rag-1 KO recipients. This effect was ameliorated by injection of anti-NKG2D blocking antibody. Together, these results suggest that cytotoxicity resulting from activation of NK cells through NKG2D leads to the development of murine bronchiolitis obliterans.

Optimal MR Plaque Imaging for Cervical Carotid Artery Stenosis in Predicting the Development of Microembolic Signals during Exposure of Carotid Arteries in Endarterectomy: Comparison of 4 T1-Weighted Imaging Techniques

BACKGROUND AND PURPOSE

Preoperative identification of plaque vulnerability may allow improved risk stratification for patients considered for carotid endarterectomy. The present study aimed to determine which plaque imaging technique, cardiac-gated black-blood fast spin-echo, magnetization-prepared rapid acquisition of gradient echo, source image of 3D time-of-flight MR angiography, or noncardiac-gated spin-echo, most accurately predicts development of microembolic signals during exposure of carotid arteries in carotid endarterectomy.

MATERIALS AND METHODS

Eighty patients with ICA stenosis (≥70%) underwent the 4 sequences of preoperative MR plaque imaging of the affected carotid bifurcation and then carotid endarterectomy under transcranial Doppler monitoring of microembolic signals in the ipsilateral middle cerebral artery. The contrast ratio of the carotid plaque was calculated by dividing plaque signal intensity by sternocleidomastoid muscle signal intensity.

RESULTS

Microembolic signals during exposure of carotid arteries were detected in 23 patients (29%), 3 of whom developed new neurologic deficits postoperatively. Those deficits remained at 24 hours after surgery in only 1 patient. The area under the receiver operating characteristic curve to discriminate between the presence and absence of microembolic signals during exposure of the carotid arteries was significantly greater with nongated spin-echo than with black-blood fast spin-echo (difference between areas, 0.258; P < .0001), MPRAGE (difference between areas, 0.106; P = .0023), or source image of 3D time-of-flight MR angiography (difference between areas, 0.128; P = .0010). Negative binomial regression showed that in the 23 patients with microembolic signals, the contrast ratio was associated with the number of microembolic signals only in nongated spin-echo (risk ratio, 1.36; 95% confidence interval, 1.01-1.97; P < .001).

CONCLUSIONS

Nongated spin-echo may predict the development of microembolic signals during exposure of the carotid arteries in carotid endarterectomy more accurately than other MR plaque imaging techniques.

Presence of nucleotide substitutions in the ABO promoter in individuals with phenotypes A3 and B3

Recently, the involvement of mutation and deletion of transcription regulatory elements in the Bm , Am , A3 and B3 phenotypes has been reported. In the present study, we carried out genetic analysis of individuals with A3 and B3 using peptide nucleic acid-clamping PCR to exclude amplification of O alleles. Two single-point mutations, -76G>C and -68G>T, were found in the ABO promoter on the A-allele in three A3 individuals and on the B allele in a B3 individual, respectively. Transient transfection of luciferase reporter plasmids carrying the same mutations into K562 cells revealed decreased luciferase activity in comparison with that carrying the wild-type promoter. These observations suggest that the mutations downregulate the promoter activity, leading to reduction in A- or B-antigen expression on red blood cells in individuals with the A3 and B3 phenotypes.

An integrated time-of-flight versus residual energy subsystem for a compact dual ion composition experiment for space plasmas

We have developed a novel concept for a Compact Dual Ion Composition Experiment (CoDICE) that simultaneously provides high quality plasma and energetic ion composition measurements over 6 decades in ion energy in a wide variety of space plasma environments. CoDICE measures the two critical ion populations in space plasmas: (1) mass and ionic charge state composition and 3D velocity and angular distributions of ∼10 eV/q-40 keV/q plasma ions—CoDICE-Lo and (2) mass composition, energy spectra, and angular distributions of ∼30 keV-10 MeV energetic ions—CoDICE-Hi. CoDICE uses a common, integrated Time-of-Flight (TOF) versus residual energy (E) subsystem for measuring the two distinct ion populations. This paper describes the CoDICE design concept, and presents results of the laboratory tests of the TOF portion of the TOF vs. E subsystem, focusing specifically on (1) investigation of spill-over and contamination rates on the start and stop microchannel plate (MCP) anodes vs. secondary electron steering and focusing voltages, scanned around their corresponding model-optimized values, (2) TOF measurements and resolution and angular resolution, and (3) cross-contamination of the start and stop MCPs' singles rates from CoDICE-Lo and -Hi, and (4) energy resolution of avalanche photodiodes near the lower end of the CoDICE-Lo energy range. We also discuss physical effects that could impact the performance of the TOF vs. E subsystem in a flight instrument. Finally, we discuss advantages of the CoDICE design concept by comparing with capabilities and resources of existing flight instruments.

Carotid plaque characterization using 3D T1-weighted MR imaging with histopathologic validation: a comparison with 2D technique

BACKGROUND AND PURPOSE

3D FSE T1WI has recently been used for carotid plaque imaging, given the potential advantages in contrast and spatial resolutions. However, its diagnostic performance remains unclear. Hence, we compared the ability of this technique to readily assess plaque characteristics with that of conventional images and validated the results with histologic classification.

MATERIALS AND METHODS

We prospectively examined 34 patients with carotid stenosis who underwent carotid endarterectomy by using 1.5T scanners and obtained 3D-FSE T1WI and 2D spin-echo T1WI scans. After generating reformatted images obtained from the 3D-FSE T1-weighted images, we calculated the contrast ratios for the plaques and the adjacent muscles and compared these findings with the pathologic classifications.

RESULTS

Carotid plaques were histologically classified as types VII, VIII, IV-V, or VI. With 3D-FSE T1WI, the range of contrast ratios for each classification was the following: 0.94-0.97 (median, 0.95), 0.95-1.29 (median, 1.10), 1.33-1.54 (median, 1.42), and 1.53-2.12 (median, 1.80), respectively. With 2D imaging, the range of contrast ratios for each classification was the following: 0.79-1.02 (median, 0.90), 0.88-1.19 (median, 1.01), 1.17-1.46 (median, 1.23), and 1.55-2.51 (median, 2.07), respectively. Results were significantly different among the 4 groups (P < .001). Sensitivity and specificity for discriminating vulnerable plaques (IV-VI) from stable plaques (VII, VIII) were both 100% for the 3D technique and 100% and 91%, respectively, for the 2D technique.

CONCLUSIONS

3D-FSE T1WI accurately characterizes intraplaque components of the carotid artery, with excellent sensitivity and specificity compared with those of 2D-T1WI.

Blood group B gene is barely expressed in in vitro erythroid culture of Bm-derived CD34+ cells without an erythroid cell-specific regulatory element

BACKGROUND AND OBJECTIVES

Previously, a weak phenotype Am or Bm was assumed to be caused by a reduction of A or B gene expression in bone marrow cells, but not in mucus-secreting cells. However, ABO expression has not been examined in erythroid progenitor cells of Am or Bm individuals.

MATERIALS AND METHODS

We carried out in vitro erythroid differentiation of CD34(+) cells from peripheral blood of a Bm individual harbouring a 3.0-kb deletion including an erythroid cell-specific regulatory element, named the +5.8-kb site, in intron 1 of the human ABO blood group gene.

RESULTS

During the in vitro differentiation of CD34(+) cells from this Bm individual into erythroid cells, B-antigens were not detectable on the cultured cells by flow cytometric analysis, and allele-specific RT-PCR consistently detected the transcripts from the O allele, but not from the B allele. Moreover, chromatin immunoprecipitation assay demonstrated that both RUNX1 and GATA-2 or GATA-1 were bound to the +5.8-kb site in cultured erythroid cells expressing ABO.

CONCLUSION

It is likely that the +5.8-kb site enhances transcription from the ABO promoter in erythroid cells through binding of RUNX1 and GATA-2 or GATA-1.

Production of human monoclonal anti-Jk3, recognising an epitope including the Jk(a) /Jk(b) polymorphic site of the Kidd glycoprotein

BACKGROUND AND OBJECTIVES

The Kidd blood group system consists of polymorphic antigens, Jk(a) (JK1) and Jk(b) (JK2), and a high-incidence antigen, Jk3. Anti-Jk3 is often observed in immunised Jk(a-b-) individuals. In this study, we aimed to establish a human hybridoma cell line secreting monoclonal anti-Jk3 (HIRO-294).

MATERIALS AND METHODS

Peripheral blood lymphocytes of a Filipino woman with the Jk(a-b-) phenotype having anti-Jk3 were transformed with Epstein-Barr virus and then hybridised with the myeloma cell line JMS-3 using the polyethylene glycol (PEG) method. The reactivity and specificity of the anti-Jk3 were examined by serology and flow cytometry.

RESULTS

Four hybridoma clones secreting anti-Jk3 were established and the antibody from one of these clones, HIRO-294, was examined. The reactivity of HIRO-294 was positive with 227 Jk(a+b-) red blood cells (RBCs), 298 Jk(a-b+) RBCs, and 1043 Jk(a+b+) RBCs, but was negative with 21 Jk(a-b-) RBCs. Eluates from Jk(a+b-) RBCs and Jk(a-b+) RBCs sensitised with the anti-Jk3 were cross-reacted with Jk(a-b+) RBCs and Jk(a+b-) RBCs, respectively. The reactivity of HIRO-294 was enhanced by the treatment of RBCs with ficin, trypsin, pronase and α-chymotrypsin, but was not changed by their treatment with neuraminidase, dithiothreitol and ethylenediaminetetraacetic acid (EDTA) glycine acid (GA). The RBCs sensitised by the anti-Jk3 were not agglutinated with the commercial reagents of anti-Jk(a) and anti-Jk(b) by saline test, whereas the nonsensitised RBCs or those sensitised by monoclonal anti-D [HIRO-3, immunoglobulin G (IgG) class] were agglutinated with those reagents.

CONCLUSIONS

We established a human hybridoma cell line secreting monoclonal anti-Jk3 (HIRO-294). This antibody had unique specificity, recognising the Kidd glycoprotein including the Jk(a) /Jk(b) polymorphic site.

JK null alleles identified from Japanese individuals with Jk(a−b−) phenotype

The Kidd blood group system consists of three common phenotypes: Jk(a+b−), Jk(a−b+) and Jk(a+b+), and one rare phenotype, Jk(a−b−). Jka/Jkb polymorphism is associated with c.838G>A (p.Asp280Asn) in exon 9 of the JK (SLC14A1) gene, and the corresponding alleles are named JK*01 and JK*02. The rare phenotype Jk(a−b−) was first found in a Filipina of Spanish and Chinese ancestry, and to date, several JK null alleles responsible for the Jk(a−b−) phenotype have been reported. We report seven novel JK null alleles, 4 with a JK*01 background and 3 with a JK*02 background, identified from Jk(a−b−) Japanese.

Predicting carotid plaque characteristics using quantitative color-coded T1-weighted MR plaque imaging: correlation with carotid endarterectomy specimens

BACKGROUND AND PURPOSE

MR plaque imaging is used to evaluate the risk of embolic complications during carotid endarterectomy and carotid artery stent placement. However, its performance for characterizing intraplaque components has varied across studies and is generally suboptimal. Hence, we correlated MR imaging results with histologic findings to determine whether a combination of high-contrast T1-weighted imaging and quantitative image analysis could readily determine plaque characteristics.

MATERIALS AND METHODS

We prospectively examined 40 consecutive patients before carotid endarterectomy by using a 1.5T scanner and axial T1-weighted spin-echo images under optimized scanning conditions. The percentage areas of intraplaque fibrous tissue, lipid/necrosis, and hemorrhage were calculated automatically by using the software with previously reported cutoff values and were compared with those of the specimens. The thickness of the fibrous cap was also measured manually.

RESULTS

The percentage areas of fibrous, lipid/necrotic, and hemorrhagic components were 5.7%-98.7%, 1.3%-65.7%, and 0%-82.0%, respectively, as determined by the MR images, whereas the corresponding values were 4.8%-92.3%, 7.0%-93.8%, and 0%-70.4%, respectively, as determined by histologic examination. Significant positive correlation and agreement were observed between MR images and histologic specimens (r = 0.92, 0.79, and 0.92; intraclass correlation coefficients = 0.91, 0.67, and 0.89; respectively). Thickness of the fibrous caps on MR images (0.21-0.87 mm) and in the specimens (0.14-0.83 mm) also showed positive correlation and agreement (r = 0.61, intraclass correlation coefficient = 0.59).

CONCLUSIONS

Quantitative analysis of high-contrast T1-weighted images can accurately evaluate the composition of carotid plaques in carotid endarterectomy candidates.

Deletion of the RUNX1 binding site in the erythroid cell-specific regulatory element of the ABO gene in two individuals with the Am phenotype

BACKGROUND AND OBJECTIVES

An erythroid cell-specific regulatory element, referred to as the +5·8-kb site, had been identified in the first intron of the human ABO blood group gene. Subsequent studies revealed that either a 5·8-kb deletion including the +5·8-kb site or disruption of a GATA factor binding motif at the site was present in all Bm and ABm individuals examined. We investigated the molecular mechanism of the Am phenotype, which is analogous to the Bm phenotype.

MATERIALS AND METHODS

Genomic DNAs were prepared from peripheral blood of two Am individuals, and the nucleotide sequences were investigated using PCR and direct sequencing. Electrophoretic mobility shift assay (EMSA) and promoter assay with K562 cells were carried out.

RESULTS

A novel 23-bp nucleotide deletion was found at the +5·8-kb site in both individuals. EMSAs demonstrated binding of the transcription factor RUNX1 to the nucleotides within the deletion. Promoter assays showed that the deletion reduced the transcriptional activity of the +5·8-kb site.

CONCLUSION

Deletion of the 23-bp nucleotides including the RUNX1 binding site decreases transcription of the A allele, resulting in the reduction in A antigen expression in the Am phenotype.

Streamline phenomena in liver metastasis of gastrointestinal tumors - a clinical-study based upon 172 patients

Location and number of liver metastasis of gastrointestinal tumors were detected preoperatively and intraoperatively. The distribution of the liver segment(s) occupied by metastatic tumors varied significantly (p<0.05). Significantly more frequent distributions were demonstrated in the lateral segment with gastric cancer (p<0.05), in the posterior segment with left colic cancer (p<0.001), in the medial segment with rectal cancer (p<0.01), in the anterior segment with bile duct cancer (p<0.05) and the whole of the liver with pancreatic cancer (p<0.05). Significantly less frequent distribution was demonstrated in the posterior segment with gastric cancer (p<0.01). When the liver was divided into the right and the left halves, the distribution of each half of the liver occupied by metastatic tumors varied significantly (p<0.05). Liver metastases of whole colic cancer were significantly more frequent in the right half of the liver (p<0.05). The results suggest that the tumor distribution in liver metastases of gastrointestinal tumors differ depending upon the primary tumors, basically in accordance with the 'streamline' phenomena.