Evaluation of automated measurement of left ventricular volume by novel real-time 3-dimensional echocardiographic system: Validation with cardiac magnetic resonance imaging and 2-dimensional echocardiography

AbstractBackgroundTraditional 3-dimensional echocardiography (3DE) with volumetric scanning technique requires several heart cycles for full-volume acquisition and complicated manual contouring of left ventricular (LV) endocardium. The new real-time 3DE (RT3DE) system allows acquisition of an instantaneous full-volume dataset in a single heart cycle and automated measurement of LV volume by the algorithm software. However, it has not been evaluated adequately whether automated measurement by RT3DE has better agreement with cardiac magnetic resonance imaging (CMR) than 2-dimensional echocardiography (2DE) with CMR.PurposeThis study aimed to evaluate the accuracy of automated measurement of LV volume using RT3DE compared with 2DE and CMR.Methods and resultsForty-four consecutive patients who underwent RT3DE, 2DE, and CMR were evaluated in this study. The feasibility of automated measurement by RT3DE was 93.2% and the mean operation time was 6min. LV volume and ejection fraction (EF) from semi-automated measurement [end-diastolic volume: r=0.96, limits of agreement (LOA) −30.5 to 39.3ml; end-systolic volume: r=0.97, LOA −22.6 to 32.7ml; EF: r=0.90, LOA −16.1 to 14.2%, respectively] had better agreement with CMR than those from 2DE (r=0.87, LOA −50.5 to 72.2ml; r=0.93, LOA −34.1 to 65.2ml; r=0.89, LOA −20.9 to 10.0%, respectively).ConclusionSemi-automated measurement by RT3DE has better agreement with CMR than 2DE in LV volume and EF. In addition, it is simple to operate and acceptable in feasibility for the clinical setting although there may be room for further learning required to incorporate small hypertrophic LV into the automated algorithm software

Minimally Invasive Spinal Stabilization with Denosumab before Total Spondylectomy for a Collapsing Lower Lumbar Spinal Giant Cell Tumor

A 21-year-old man consulted our hospital for treatment of a spinal giant cell tumor (GCT) of Enneking stage III. Lower lumbar-spine tumors and severe spinal canal stenosis are associated with high risk for surgical mor-bidity. Stability was temporarily secured with a percutaneous pedicle screw fixation in combination with deno-sumab, which shrank the tumor. Total en bloc spondylectomy was then performed 6 months after initiation of denosumab, and the patient was followed for 3 years. There was no local recurrence, and bony fusion was obtained. Minimally invasive surgery and denosumab allowed safer and easier treatment of a collapsing lower lumbar extra-compartmental GCT

The Earth effects on the supernova neutrino spectra

The Earth effects on the energy spectra of supernova neutrinos are studied. We analyze numerically the time-integrated energy spectra of neutrino in a mantle-core-mantle step function model of the Earth's matter density profile. We consider a realistic frame-work in which there are three active neutrinos whose mass squared differences and mixings are constrained by the present understanding of solar and atmospheric neutrinos. We find that the energy spectra change for some allowed mixing parameters. Especially, the expected number of events at SNO shows characteristic behavior with respect to energy, i.e. a great dip and peak. We show that observations of the Earth effect allow us to identify the solar neutrino solution and to probe the mixing angle $\theta_{2}$.Comment: 19 pages, 6 figures, corrected versio

Abscess Formation of the Round Ligament of the Liver: Report of a Case

Abscess formation of the round ligament of the liver is very rare. We report a case of a 70-year-old female with abscess of the round ligament after an endoscopic papillotomy for choledocholithiasis. On the 21st day following papillotomy, abscess formation of the round ligament was found by ultrasonographic examination. Surgical treatment was performed because conservative therapy was not effective. The purulent fluid and necrotic tissue at the round ligament were completely removed. Cultures obtained from the abscess grew Staphylococcus epidermidis, but the mechanism of abscess formation in this case remains unclear.</p

Multiple gastrointestinal stromal tumors in neurofi bromatosis type 1 treated with laparoscopic surgery

Gastrointestinal stromal tumors (GISTs) have been reported to occasionally occur in patients with neurofi bromatosis type 1 (NF-1), and many cases have had multiple lesions predominantly involving the small intestine. We report herein a case of multiple GISTs associated with NF-1 from whom laparoscopic surgery was benefi cial. In a 79-year-old female admitted with anemia and melena, the abdominal computed tomography revealed a tumor arising from the small intestine. Laparoscopic surgery was performed, and another small tumor was revealed during laparoscopic observation. Extracorporeal partial and wedge resection of the small intestine were undertaken. Both lesions were diagnosed as typical GISTs of low risk. Laparoscopic surgery would be useful for examination and a minimally invasive approach to tumors of the small intestine, especially on cases with the possibility of multiple tumors.</p

Two-dimensional spectroscopic observation of a pulse-modulated induction thermal plasma torch for nanopowder synthesis

The two-dimensional distributions of spectral radiation intensities in the plasma torch were observed for the pulse modulated induction thermal plasmas (PMITP) with continuous or intermittent feedstock feeding for TiO2 nanopowder synthesis. For this observation, an imaging spectrophotometer with a high speed video camera were adopted. The evaporation of feedstock Ti powder, the formation of TiO and TiO transportation were investigated from the observation results of a Ti atomic spectral line and TiO molecule spectra as well as those of Ar and O atomic lines. An interpretation was suggested from the observation results for Ti feedstock evaporation and TiO formation in nanoparticle synthesis using a PMITP with intermittent feedstock feeding

Factors responsible for elevated plasma B-type natriuretic peptide levels in severe aortic stenosis: Comparison between elderly and younger patients

AbstractBackgroundElevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS.MethodsWe performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm2] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups.ResultsAge was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e′ were significantly higher in elderly than younger patients [133.0 (IQR, 73.3–329.7)pg/dl vs 92.8 (IQR, 40.6–171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e′, estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e′, eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index.ConclusionsThere may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients

A large amount synthesis of nanopowder using modulated induction thermal plasmas synchronized with intermittent feeding of raw materials

A large amount synthesis method for titanium dioxide (TiO2) nanopowder is proposed by direct evaporation of titanium powders using Ar-O 2 pulse-modulated induction thermal plasma (PMITP). To realize a large amount synthesis of nanopowder, the PMITP method was combined with the intermittent and heavy load feeding of raw material powder, as well as the quenching gas injection. The intermittent powder feeding was synchronized with the modulation of the coil current sustaining the PMITP for complete evaporation of the injected powder. Synthesized particles by the developed method were analyzed by FE-SEM and XRD. Results indicated that the synthesized particles by the 20-kW PMITP with a heavy loading rate of 12.3 g min-1 had a similar particle size distribution with the mean diameter about 40 nm to those with light loading of 4.2 g min-1

Successful treatment of mycotic thoracic aortic aneurysm in collaboration with cardiovascular and general thoracic surgeons

We report a rare case of ruptured mycotic thoracic aortic aneurysm that required almost one month for correct diagnosis. A 71-year-old woman who had hemoptysis for several weeks was initially suspected to have lung cancer based on several examinations, including fluorine-18 fluorodeoxyglucose-positron emission tomography. However, contrast-enhanced computed tomography revealed a ruptured mycotic thoracic aortic aneurysm in the lower lobe of the left lung. She underwent emergency surgery carried out collaboratively by cardiovascular and general thoracic surgeons. En bloc resection of the aneurysm with the left lower lobe and in situ graft replacement of the descending aorta were performed successfully, although left lower lobectomy was difficult due to the insufficient segmentation of the upper and lower lobes and strong adherence of the aneurysm to the left lung. The clinical course was uneventful. The reason for survival for one month was thought to be that the rupture was covered by the lung. Because the resection of the lung is often difficult in cases in which the aneurysmal rupture shows extensive lung invasion, collaboration with cardiovascular and general thoracic surgeons is important

Effects of Neutrino Oscillation on the Supernova Neutrino Spectrum

The effects of three-flavor neutrino oscillation on the supernova neutrino spectrum are studied. We calculate the expected event rate and energy spectra, and their time evolution at the Superkamiokande (SK) and the Sudbury Neutrino Observatory (SNO), by using a realistic neutrino burst model based on numerical simulations of supernova explosions. We also employ a realistic density profile based on a presupernova model for the calculation of neutrino conversion probability in supernova envelopes. These realistic models and numerical calculations allow us to quantitatively estimate the effects of neutrino oscillation in a more realistic way than previous studies. We then found that the degeneracy of the solutions of the solar neutrino problem can be broken by the combination of the SK and SNO detections of a future Galactic supernova.Comment: 10 pages, 14 figures, corrected versio