Influence of myopotential interference on the Wavelet discrimination algorithm in implantable cardioverter-defibrillator

Background: Wavelet is a morphology-based algorithm for detecting ventricular tachycardia. The electrogram (EGM) source of the Wavelet algorithm is nominally programmed with the Can-RV coil configuration, which records a far-field ventricular potential. Therefore, it may be influenced by myopotential interference. Methods: We performed a retrospective review of 40 outpatients who had an implantable cardioverter-defibrillator (LCD) with the Wavelet algorithm. The percent-match score of the Wavelet algorithm was measured during the isometric chest press by pressing the palms together. We classified patients with percent-match scores below 70% due to myopotential interference as positive morphology change, and those with 70% or more as negative morphology change. Stored episodes of tachycardia were evaluated during the follow-up. Results: The number of patients in the positive morphology change group was 22 (55%). Amplitude of the Can-RV coil EGM was lower in the positive morphology change group compared to that in the negative group (3.9 +/- 1.3 mV vs. 7.4 +/- 1.6 mV, P=0.0015). The cut-off value of the Can-RV coil EGM was 5 mV (area under curve, 0.89). Inappropriate detections caused by myopotential interference occurred in two patients (5%) during a mean follow-up period of 49 months, and one of them received an inappropriate LCD shock. These patients had exhibited positive morphology change. Conclusions: The Wavelet algorithm is influenced by myopotential interference when the Can-RV coil EGM is less than 5 mV

Two-Stage Polyhydroxyalkanoates (PHA) Production from Cheese Whey Using Acetobacter pasteurianus C1 and Bacillus sp. CYR1

Cheese whey (CW) can be an excellent carbon source for polyhydroxyalkanoates (PHA)-producing bacteria. Most studies have used CW, which contains high amounts of lactose, however, there are no reports using raw CW, which has a relatively low amount of lactose. Therefore, in the present study, PHA production was evaluated in a two-stage process using the CW that contains low amounts of lactose. In first stage, the carbon source existing in CW was converted into acetic acid using the bacteria, Acetobacter pasteurianus C1, which was isolated from food waste. In the second stage, acetic acid produced in the first stage was converted into PHA using the bacteria, Bacillus sp. CYR-1. Under the condition of without the pretreatment of CW, acetic acid produced from CW was diluted at different folds and used for the production of PHA. Strain CYR-1 incubated with 10-fold diluted CW containing 5.7 g/L of acetic acid showed the higher PHA production (240.6 mg/L), whereas strain CYR-1 incubated with four-fold diluted CW containing 12.3 g/L of acetic acid showed 126 mg/L of PHA. After removing the excess protein present in CW, PHA production was further enhanced by 3.26 times (411 mg/L) at a four-fold dilution containing 11.3 g/L of acetic acid. Based on Fourier transform infrared spectroscopy (FT-IR), and H-1 and C-13 nuclear magnetic resonance (NMR) analyses, it was confirmed that the PHA produced from the two-stage process is poly-beta-hydroxybutyrate (PHB). All bands appearing in the FT-IR spectrum and the chemical shifts of NMR nearly matched with those of standard PHB. Based on these studies, we concluded that a two-stage process using Acetobacter pasteurianus C1 and Bacillus sp. CYR-1 would be applicable for the production of PHB using CW containing a low amount of lactose

Cellular Morphology Visualization to Probe Cell Differentiation

Nuclear and cytoplasmic morphological changes provide important information about cell differentiation processes, cell functions, and signal responses. There is a strong desire to develop a rapid and simple method for visualizing cytoplasmic and nuclear morphology. Here, we developed a novel and rapid method for probing cellular morphological changes of live cell differentiation process by a fluorescent probe, TAP-4PH, a 1,3a,6a-triazapentalene derivative. TAP-4PH showed high fluorescence in cytoplasmic area, and visualized cytoplasmic and nuclear morphological changes of live cells during differentiation. We demonstrated that TAP-4PH visualized dendritic axon and spine formation in neuronal differentiation, and nuclear structural changes during neutrophilic differentiation. We also showed that the utility of TAP-4PH for visualization of cytoplasmic and nuclear morphologies of various type of live cells. Our visualizing method has no toxicity and no influence on the cellular differentiation and function. The cell morphology can be rapidly observed after addition of TAP-4PH and can continue to be observed in the presence of TAP-4PH in cell culture medium. Moreover, TAP-4PH can be easily removed after observation by washing for subsequent biological assay. Taken together, these results demonstrate that our visualization method is a powerful tool to probe differentiation processes before subsequent biological assay in live cells

同時性4重複癌の一例

近年,癌の診断技術の進歩や治療成績の向上に伴い重複癌の報告が増加しているが,同時性4重複癌の頻度は0.21%と稀である.超音波検査によるスクリーニングが診断に有用であった同時性4重複癌の一例を報告する.症例は69歳の男性で肝障害と高血圧で定期通院中であった.増大する無痛性頸部腫瘤を自覚し頸部超音波検査を施行し,転移性リンパ節腫大を疑い,同日に腹部超音波検査を行った.その結果,進行胃癌と進行大腸癌を疑い,消化管精査を開始した.精査の結果,中咽頭癌,食道癌,胃癌,直腸癌の同時性4重複癌であった.最も進行度の高い中咽頭癌から治療を開始し,現在外来通院中であるが,経過は良好である.1990年から2013年の間で医中誌による検索では同時性4重複癌の報告は自験例を含めて15例に過ぎない.その15例で検討を行うと男性に多く,罹患臓器は胃癌と食道(8.8%),または胃癌と直腸の重複(6.9%)と消化管領域での重複を多く認めた.重複癌の発生要因としては飲酒や喫煙などの嗜好品,遺伝的要因が報告されている.飲酒習慣については飲酒後の顔面の紅潮(フラッシャー)は発癌リスクが有意に高まるとされ,本症例でもBrinkman Index 1350,Sake Index 180と高値であり,更にフラッシャーであり複数のリスク因子を認めた.遺伝的要因については家族性大腸腺腫症やLynch症候群での多臓器癌の発症が知られているが,本症例では病理標本での検討の結果,その可能性は否定的であった.癌の治療方針決定においては,進行度の評価が重要となるため,全身のスクリーニングが必要であるが,超音波検査は非侵襲かつ放射線被曝もないことから,スクリーニングに適した検査法と考えられた.According to the recent advancement in diagnosis technique for cancers, the incidence of patients with cancer has been increasing. However, cases with synchronous quadruple cancers are rarely found. In this paper, we report a case of synchronous quadruple cancers located in the pharynx, esophagus, stomach and rectum. A 69-year-old man complained of swelling in the cervical lymph nodes, suspected to be metastasis by cervical ultrasonographic examination. Additionally, advanced gastric cancer and advanced rectal cancer were suspected via an abdominal ultrasonography (US). Thereafter, subsequent detailed examinations revealed the quadruple cancers, including advanced middle pharyngeal cancer, early-stage esophageal cancer, advanced gastric cancer and advanced rectal cancer. Chemoradiation therapy was performed for pharyngeal cancer as a neoadjuvant treatment because it was at the most advanced clinical stage. The patient had a good clinical course after the treatment. In Japan, we identified 14 case reports about synchronous quadruple cancers through the Japan Medical Abstracts Society database between the years 1990 to 2013. Summarizing all these cases, including our case, showed the following findings: male (13 cases) were predominant with a combination of gastric cancer and esophageal cancer (8.8%), or the combination of gastric cancer and rectal cancer (6.9%) were also common. Furthermore, cigarette smoking and alcohol consumption were considered the major risk factors for patients presenting with multiple cancers. Our patient was found to have both risks such as Brinkman Index 1350 and Sake Index 180. The treatment order for patients with cancer should be determined by its clinical stage. Screening examinations for checking metastasis or other organic diseases are important. Ultrasonography (US) is noninvasive and free from radiation exposure and it is a useful modality for patients with cancer

体外式腹部超音波が診断に有用であった十二指腸巨大Brunner 腺過形成の一例

Brunner 腺過形成は十二指腸腫瘍性病変で，大きさが40mm を超えるものは10% 未満と稀である．医学中央雑誌で「腹部超音波」「Brunner 腺過形成」のキーワードで検索すると，関連した報告はない．体外式超音波検査（US）が診断に有用であったBrunner 腺過形成の一例を報告する．症例は50歳代，女性．食欲不振，心窩部痛とタール便を主訴に近医受診．貧血を認め，出血源検索目的に行った上部消化管内視鏡検査（EGD）で胃内に約 45 mm の腫瘤性病変を認め精査目的に当院紹介となった．血液生化学検査ではHb 9.1 g/dl，MCV 89.1 fl，MCH 30.0 pg と正球性正色素性貧血を認め，BUN/CRE 比は43.1と上昇していた．当院でのEGD では十二指腸球部に内腔をほぼ閉塞する45×40 mm の腫瘤性病変を認めた．腫瘤表面の異型性は目立たないが，oozing bleeding を伴ったびらん形成を認めた．粘膜下腫瘍を疑い生検も行われたが確定診断には至らなかった．単純造影CT では十二指腸球部に 45 mm 程度の腫瘤性病変を認め，辺縁は遷延性に造影された．内部は低吸収域が認められ，嚢胞変性や壊死が疑われた．周囲臓器への浸潤や転移を示唆する所見は認めず，粘膜下腫瘍が疑われたが癌は否定できなかった．US では十二指腸球部後壁の第２層から第３層に存在する約55 mm の粘膜下腫瘍が認められた．固有筋層は正常で，内部は大半が多房性嚢胞からなり，嚢胞間に充実成分がみられた．血流は比較的豊富であるが血管径や形状に明らかな不整は認めなかった．以上より十二指腸Brunner 腺過形成が疑われた．外科的切除の方針となり，開腹で十二指腸粘膜下層剥離術を行った．術材の組織診断はBrunner 腺過形成で超音波診断と矛盾しない所見であった．十二指腸粘膜下腫瘍の鑑別には超音波内視鏡が有用であるが，大きな病変では全体の描出が困難などの欠点もある．一方でUS は内視鏡侵襲なく，比較的大きな病変も描出可能で，特に本症例の様に前庭部付近は良好な観察が期待できるため，上部消化管の精査に応用できる．Brunner’s gland hyperplasia is a duodenal neoplastic lesion, and its lesions measuring >40 mm in diameter are rare, accounting for <10% of cases. A search of the Ichushi (Japana Centra Revuo Medicina) database using the keywords “abdominal ultrasound” and “Brunner’s gland hyperplasia” yielded no relevant articles. Here we report a case of Brunner’s gland hyperplasia in which transabdominal ultrasonography (US) was useful for diagnosis. A female in her 50s presented to a local hospital complaining of anorexia, epigastric pain and tarry stool. She had anemia and esophagogastroduodenoscopy (EGD), which was performed to identify the source of bleeding, revealed a mass lesion measuring approximately 45 mm in diameter in the stomach. She was referred to our hospital for further examination. Blood biochemistry showed a hemoglobin (Hb) level of 9.1 g/dL, mean corpuscular volume (MCV) of 89.1 fL and mean corpuscular hemoglobin (MCH) of 30.0 pg, indicating normocytic normochromic anemia. The blood urea nitrogen (BUN)/creatinine (CRE) ratio was as high as 43.1. In our hospital, EGD revealed a 45×40 mm mass lesion almost obstructing the lumen in the duodenal bulb. Atypia of the mass surface was not prominent, but erosion with oozing bleeding was observed. A submucosal tumor was suspected, and biopsy was performed but did not lead to a definitive diagnosis. Plain contrast-enhanced computed tomography (CT) revealed a mass lesion with prolonged peripheral enhancement measuring approximately 45 mm in diameter in the duodenal bulb. There was a low-density area inside the mass, raising the suspicion of cystic degeneration and necrosis. There were no findings suggesting infiltration or metastasis to the surrounding organs, raising the suspicion of a submucosal tumor, but cancer could not be ruled out. US revealed a submucosal tumor measuring approximately 55 mm in diameter in the second to third layer of the posterior wall of the duodenal bulb. The muscularis propria was normal and mostly composed of multilocular cysts with solid components in the space between the cysts. Blood flow was relatively abundant, but there were no obvious irregularities in the diameter or shape of blood vessels. The above findings raised the suspicion of duodenal Brunner’s gland hyperplasia. It was decided to perform surgical resection, and she underwent open duodenal submucosal dissection. Histology of the surgical specimen revealed Brunner’s gland hyperplasia, cons istent with the ultrasonographic findings. Endoscopic ultrasonography is useful in the differential diagnosis of duodenal submucosal tumors, but also has disadvantages such that it is difficult to visualize the entire lesion, when the lesion is large. On the other hand, US can be applied to the detailed examination of the upper gastrointestinal tract, because there are no invasive endoscopic procedures and US can visualize relatively large lesions and, in particular, can be expected to satisfactory observe around the vestibule, like in the present case

当院における便潜血陽性者に対する大腸CT(CTコロノグラフィー)検査の有用性:大腸がん検診への導入と課題

大腸がん検診におけるスクリーニング検査としての大腸CT(CT colonography: CTC)検査の有用性を検討するために,当院における便潜血陽性者に対するCTCと大腸内視鏡検査の精度比較を行った.2009年7月から2014年1月までに川崎医科大学附属病院で施行されたCTC検査673件中,スクリーニング目的で行われた411件の中で便潜血陽性者に対して行われた183名を対象とした.全例CTC検査と同日に全大腸内視鏡検査も行った.対象とする病変は内視鏡観察あるいは病理組織学的に腺腫,がんと診断されたものとした.CTCの前処置は,経口腸管洗浄剤に水溶性造影剤による標識(タギング)を付けて行った.CT装置は16列Multi-slice CT(MSCT),腸管拡張は自動炭酸ガス注入器を使用した.CTC読影は,まず仮想内視鏡(3D)で行い,後に多断面再構成像(Multi-planar reconstruction: MPR 像(2D))を行う3D primary 法で行った.183名(男性98名,女性85名,年齢40～86歳,平均年齢62.1歳±0.8歳)のうち,病変を認めなかったのは87名(47.5%)であり,病変を認めたのは96名(53%)であった.総病変数は191個であり,うち6mm以上の病変は77個(40%)で,そのうち10mm以上のものは46個(24%)であった.大腸癌は25例(全病変中13%)で,うち腺腫内癌16例(全病変中8%)であった.側方発育型腫瘍は8例(4%)(大きさ平均17mm)であった.病変のうち,内視鏡的切除が行われたものは34病変であり,手術が行われたものは22病変であった.病変形態別による描出率は隆起型病変80%で,平坦型病変65%であった.病変サイズ別の精度は10mm以上の病変(n=46)で感度96%,陽性適中率98%であり,6mm以上の病変(n=77)で感度83%,陽性適中率79%であった.CTCは便潜血陽性者において良好な精度を示し,大腸がんスクリーニング法としての可能性がある.The purpose of this study was to estimate the sensitivity and specificity of CT colonography (CTC) for colorectal cancer screeing following positive fecal occult blood test (FOBT) in Japan. To compare detection rates of colorectal cancer and adenoma between CTC and optical total colonoscopy (TCS). This study included 183 patients with positive result of FOBT in Japanese colorectal cancer screening program. The patients had both CTC and TCS on the same day. 96 patients (53%) had colorectal lesions, on the other hand 87 patients had no lesions. The total number of lesions was 191, including 77 lesions 6 mm in maximum diameter and larger, including 46 lesions 10 mm and larger