Pulmonary Hemodynamics and Six-Minute Walk Test Outcomes in Patients with Interstitial Lung Disease

Background. Six-minute walk test (6MWT) has 3 measurement outcomes, which are walk distance, desaturation, and symptom. The aim of this study was to examine whether routinely measured right-heart catheter (RHC) data correlate with 6MWT outcomes in patients with interstitial lung disease (ILD). Methods. Between June 2010 and December 2012, consecutive patients with ILD who underwent evaluation, including pulmonary function test, hemodynamic studies with right-heart catheter, and 6MWT as routine general practice, were recruited. Correlates of 3 outcomes of 6MWT were examined to reveal significant predictors. Results. Forty-six patients consisting of 20 with idiopathic pulmonary fibrosis, 14 with collagen vascular disease associated ILD, and 12 with other idiopathic interstitial pneumonia were recruited (mean % predicted FVC: 76.7±17.1%). Several physiological variables, including mean pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR), were correlated with each 6MWT outcome. Stepwise multivariate regression analyses showed that % predicted FVC and % predicted DLco were independent predictors of walk distance (r2=0.35, p=0.0002). For SpO2 at the end of 6MWT, % predicted DLco and PVR were selected as independent predictors (r2=0.46, p<0.0001). For dyspnea at the end of 6MWT, % predicted DLco was only one predictor (r2=0.18, p=0.005). Conclusion. Mean PAP had little impact on 6MWT outcomes in ILD patients who were nonselectively recruited, although PVR was one of predictors of desaturation

〈Originals〉Relationship between clinical manifestations and CMR findings in cardiac sarcoidosis

[Abstract] Background : Different cardiac manifestations/events have been reported in patients with sarcoidosis ; however, factors related to the onsetof manifestations in cardiac sarcoidosis (CS) remain unclear. Late gadolinium-enhancement cardiac magnetic resonance (LGE-CMR) has been used to detect myocardial damage/fibrosis. Therefore, we examined the characteristics of clinical manifestations in CS patients using LGE-CMR. Methods : Thirty-three consecutive CS patients underwent CMR. According to the mural location of LGE ; mid-wall, epicardial, or transmural, the LGE pattern was classified into three groups : A : LGE existing at one location only, B: LGE at any two locations, C : LGE at all locations. CMR findings were also analyzed in relation to each clinical manifestation. Results : Myocardial damage was detected by LGE imaging in 91% of the patients and was most frequently observed in the basal septal myocardium. %LGE area was negatively correlated with LV ejection fraction (EF) (P <0.01). Significantly decreased LV EF and increased %LGE area were observed in Group B and C. In addition, all patients in group C exhibited a clinical manifestation. The patients with high-grade atrioventricular block showed the increased %LGE area (P < 0.01). Although occurrence of ventricular tachycardia was not associated with any changes in LV EF, mass, and %LGE area, hospitalization for heart failure was associated with reduced LV EF, and increased mass and %LGE area (P<0.05 for all).Conclusions : Different clinical manifestations in CS have been associated with the development of myocardial fibrosis/damage and resultant myocardial dysfunction shown by CMR. CMR may be useful for characterizing the pathophysiology of respective clinical manifestations/events

Comparison of CBF between pCASL and SPECT

Purpose: We compared the regional cerebral blood flow (rCBF) obtained by pulsed continuous arterial spin labeling (pCASL) and iodine-123-N-isopropyl-p-iodoamphetamine (IMP) single photon emission computed tomography (SPECT) using 3-dimensional stereotactic region-of-interest (ROI) software for automated definition of ROIs in anatomic regions of the brain. Methods: Thirteen patients with cerebrovascular occlusive disease and three with transient ischemic attacks underwent pCASL and IMP SPECT imaging. We compared rCBF values of each anatomic region and calculated the correlation coefficients between pCASL and IMP SPECT. We also calculated the asymmetry index (AI) using ROIs in contralateral regions of the hemispheres. Results: The rCBF values calculated from pCASL and IMP SPECT were comparable in most segments, but rCBF in the thalamus (P < 0.0001) and hippocampus (P = 0.0006) was significantly higher measured by pCASL than IMP SPECT. The correlation of rCBF between pCASL and IMP SPECT in the affected hemisphere (r = 0.50) tended to be lower than that in the normal hemisphere (r = 0.59), but not significantly different (P = 0.25). Moreover, there was a fixed bias for underestimation of rCBF by pCASL (P = 0.0047) in the affected hemisphere. The calculated AI showed a significant relationship between methods (r = 0.79, P < 0.0001). Conclusion: The rCBF obtained by pCASL had positive relationships with IMP SPECT. However, it should be considered that pCASL tends to have a weak relationship with IMP SPECT in some normal regions and regions affected by cerebrovascular occlusive disease

Alteration of default mode network in children with autism spectrum disorder

Purpose : The purpose of this study was to investigate changes in the functional connectivity of the default mode network (DMN) in normal aging and in children with autistic spectrum disorder (ASD) by using resting-state functional magnetic resonance imaging (rsfMRI) and independent component analysis. Methods : Thirty-one healthy controls (HC) in four age groups (1-3, 4-8, 20-29, and 50-59 years) and 14 childhood ASD cases (1-8 years of age) were examined by rsfMRI echo-planar imaging on a clinical 3-T MRI scanner. Imaging of all children (1-8 years) was conducted under sedation, while adults were scanned in the awake state with eyes closed. Results : The regions of DMN functional connectivity in the bilateral inferior parietal lobule and posterior cingulate cortex were smaller in HC children than in HC adults, and smaller in the ASD group than in the HC children. Conclusion : It is possible to observe developmental and pathological changes in the DMN by rsfMRI. Reduced DMN functional connectivity in children may be a useful biomarker for ASD diagnosis

Percolation induced gel-gel phase separation in a dilute polymer network

Cosmic large-scale structures, animal flocks, and living tissues are non-equilibrium organized systems created by dissipative processes. Despite the uniqueness, the realization of dissipative structures is still difficult. Herein, we report that a network formation process in a dilute system is a dissipative process, leading to percolation induced gel-gel phase separation (GGPS) in a prominent miscible polymer-water system. The dilute system, which forms a monophase structure at the percolation threshold, eventually separates into two gel phases in a longer time scale as the network formation progresses. The dilute hydrogel with GGPS exhibits an unexpected mesoscale co-continuous structure and induces adipose growth in subcutaneous. The formation mechanism of GGPS and a cosmic large-scale structure is analogous, in terms of attractive interactions in a diluted system driving phase separation. This unique phenomenon unveils the possibility of dissipative structures enabling advanced functionalities and will stimulate research fields related to dissipative structures.Comment: 23+5 pages, 4+4 figure

日本とその近隣諸国で分離されたShigella sonneiのコリシン型,生化学型および薬剤耐性パターン

A modification of Abbott and Shannon\u27s colicin typing method for Shigella sonnei which was established recently as a standard method in Japan was described. This method increases by three or four indicators of E. coli K-12 mutant origin, and it is not only to make a clear distinction between either types 6 and 11 or types 4 and 14, but also to establish three new colicin types 4A, 9A and 13A. Typing results of 1,148 strains representing "foci" which were isolated in Japan especially in the western part, were presented. In Japan at present, type 14 is at the top of epidemic strains, type 6 ranks next, and types O, 8, 13A, 4, 2, etc. follow in order, among them only types 8 and 13A show some difference in interregional distribution. Besides, 39 strains isolated in the neighboring countries of Japan were used for typing. There was a most distinct difference in colicin type between here and there. The strains examined biochemically were determined by 78 percent as type RM of Gillies (xylose negative, raffinose and melibiose positive), and by 96 percent as type "a" of Szturm-Rubinsten (ONPG positive, rhamnose and xylose negative). Both the biochemical types were equally distributed among colicin types other than type 12; in colicin type 12, strains showing various fermentation patterns were found. The resistance of the strains to sulfa-drug and three antibiotics raised gradually since 1963 and thereabout, and it was at its maximum in 1967 irrespective of colicin type. Only strains of colicin type 14, which appeared for the first time in 1963 showed the maximum from the beginning. In the transition stage of resistance acquisition, it was possible to use resistance pattern as a subsidiary epidemiological marker in combination with colicin type provided that epidemics had been caused by colicin types 6, O, 8, etc. Two examples of application of this combination use were presented; the first case deals with epidemiological analysis of a mass outbreak, and the second with epidemiological connection among many epidemics in a district within a definite period of time.日本で改良され,標準法として一般に実施されているAbbott-ShannonのShigella sonneiコリシン型別法(いわゆる型別部会法)を紹介した.本法は大腸菌K-12変異菌から誘導した抵抗変異株3ないし4株を原法指示菌に追加したもので,原法では区別が困難であった6型と11型,および4型と14型を明瞭に分け,また新コリシン型3種,4A,9A,13Aを追加したものである.主として西日本で分離された,ホーカスを代表する1,148株のS. sonneiが本法による型別に供された.現在の日本では14型が首位,6型これに次ぎ,O型,8型,13A,4≦,2型などがこの順に検出され,うち8型と13Aは国内的に地理的分布上のかなりの差異を示した.ほかに近隣諸国分離の39株を型別したが,その成績は日本のそれと大いに差異があった.生化学的型別の結果は,78%までがGilliesのRM型(キシローゼ陰性,ラフィノーゼ,メリビオーゼ陽性),96%までがSzturm-Rubinstenのa型(ONPG陽性,ラムノーゼ,キシローゼ陰性)であった.この両型はともに12型以外の各コリシン型に平均的に分布し,12型においてのみ各種の糖分解型式を示すものが見出された.これらの菌株のサルファ剤と3種の抗生物質に対する抵抗性は1963年頃から次第に高まり,1967年に至ってコリシン型に関係なくすべてが最高の抵抗を示した.ただし14型だけはそれが最初に現われた1963年には,4剤に対して既に最高の抵抗を示していた.この耐性獲得の途上にある時期では,6型,O型,8型などによる流行の場合に限って,薬剤耐性パターンをコリシン型と組合せて一つの補助的な疫学的マーカーとして利用することが可能であった.この組合せ使用の二つの応用例を記述したが,一つはある集団発生の疫学的分析に関するものであり,もう一つは,ある地方ある期間内における各流行例間の関連に関するものであった

〈Originals〉Relation between low take-off of the left atrial appendage and thromboembolic events in patients with atrial fibrillation : evaluation with multi-detector CT

[Abstract] The left atrial appendage (LA-Ap) is one of the major sources of cardiac thrombus formation responsible for thromboembolism inpatients with atrial fibrillation (AF). We hypothesized that the particular anatomical characteristics of the LA-Ap may facilitate thrombus formation. Methods : Seventy-four AF patients underwent transesophageal echocardiography (TEE) and multi-detector CT (MDCT) examinations. These patients were divided into two groups, with and without systemic embolism (Emb) [Emb (+) group, 10 patients, male/female =7/3 ; Emb (—) group, 64 patients, male/female = 51/13]. To evaluate the location of the LA-Ap in relation to the left atrium (LA), we determined four distinctive points on MDCT images using two carefully defined orthogonal sections : the superior summit of the mitral annulus (point-A), the anterior and posterior sites of the LA-Ap orifice (point-B and C), and the posterior LA (point-D). Next, we evaluated the relation of the geometrical intervals (A-B, B-C, C-D) to the prior thromboembolism. Results : Using multivariate analysis, a shorter A-B interval was recognized as an independent factor positively associated witha history of thromboembolism. Conclusion : The position of the LA-Ap orifice may affect the hemodynamic state of the LA-Ap, and anterior deviation of the LA-Ap orifice (low take-off of the LA-Ap) may be a risk factor for thrombus formation in LA-Ap and systemic embolism