Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs

BACKGROUND: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography. PATIENTS AND METHODS: Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. RESULTS: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. CONCLUSIONS: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Kinematic Analysis of Sit-to-Stand Motion in Knee Osteoarthritis

[目的]本研究は,体幹および下肢の運動連鎖の観点から変形性膝関節症(膝OA)の発症・進行に関与する機能障害を明らかにするために,膝OA患者における椅子からの立ち上がり動作(STS)の運動学的分析を行った。[対象]膝OAと診断された女性17名の膝OA群と膝関節痛を有さない女性16名の対照群とした。[方法]課題動作は座面高が下腿長の高さの椅子からのSTSとした。3次元動作解析システムKinema Tracer(キッセイコムテック社製)を用いて各体節および下肢関節の角度を求めた。[結果]身体重心(COM)前方移動期における各体節の角速度の平均値には有意差が認められなかったが,COM上方移動期における膝関節伸展,足関節底屈の角速度平均値は対照群に比し,膝OA群が有意に小さかった。[結語]膝OA群のSTSにおいて,臀部離床後に体幹前傾で得られた速度を下肢に伝えることができず,適切な膝関節の関節運動および肢節のアライメント保持が難しくなっていることが示唆された。[Purpose] The purpose of this study was to analyze the kinematics of sit-to-stand motion (STS) in subjects with knee osteoarthritis (knee OA) and to demonstrate the factor of impairment responsible for pathogenesis and progression of knee OA based on discussion from the standpoint of the kinetic chain of the thorax-pelvis-lower extremity. [Subjects] The subjects were 17 patients with knee OA and 16 age-matched asymptomatic controls. [Methods] Subjects performed STS from a chair with a seat adjusted to the height of the subject's lower leg. Kinematic data of the body segment and joint angles were collected using a motion analysis system (Kissei Comtec). [Results] There were no significant differences between joint angular velocity averages of the body segment in forward movement of center of mass (COM), but those of the knee and ankle in upward movement of COM were significantly smaller. [Conclusion] These results suggest that knee OA subjects can't transfer kinetic energy generated in trunk forward tilting to the lower extremity, making it difficult for them to keep appropriate knee movement and alignment

Study on performance of chemical heat storage system for direct steam generation

A heat storage system that is used to generate steam directly by exploiting the dissolution phenomenon between CaBr2 and water was studied. The performance of the system in terms of the coefficient of performance (COP) or volumetric heat capacity (VHC) yielded maximal values for the amount of water supplied. The COP was 0.072 to 0.115 for steam pressures of 20-50 kPa at x = 7.5. VHC values recorded were 177.2 to 250.1 kJ/l for steam pressures of 20-50 kPa at x = 7.5. This calculation was validated by comparing the calculated value with the experimental result. The pressure settled at the equilibrium state for a very short duration at the heat release step, proving that the dissolution phenomenon involved a high mass transfer rate and was able to transform the heat of dissolution into enthalpy of steam. The amount of steam generated in the experiment conformed very well to the calculations, thus validating the calculation method. (C) 2014 AIP Publishing LLC

平成29年度の活動 国際交流 : ニュージーランド・カイコウラ地震に関する調査

"Landslide dams caused by the M7.8 Kaikoura Earthquake"INTERPRAEVENT2018. 平成30年10月1～4日. 富山国際会議場, 富山県