Search

Purpose Early detection of medial meniscus posterior root tear (MMPRT) is important in preventing the rapid onset and progression of degenerative knee disease. Diagnosis is facilitated by the availability of non-weight-bearing X-ray view, but information on the X-ray characteristics of MMPRT is scarce. Here, we conducted a pilot study of the X-ray characteristics of MMPRT on non-weight-bearing tunnel view. Methods We retrospectively reviewed 43 consecutive patients treated in the outpatient department for medial knee pain or popliteal pain. Patients were divided into MMPRT (21 knees) and non-MMPRT groups (22 knees). We investigated X-ray characteristics and magnetic resonance imaging findings. Femorotibial angle, posterior tibial slope, medial tibial eminence (MTE)–medial femoral condyle (MFC) distance (contralateral and affected sides, and difference between the two), medial tibiofemoral joint (MTFJ) width (contralateral and affected sides, and difference between the two), and meniscus radial dislocation between the groups were evaluated using the Mann–Whitney U test. The association between X-ray characteristics and MMPRT was determined using univariate and multivariate logistic regression analyses. Results A highly significant difference between the affected and contralateral sides was seen in MTFJ width and MTE–MFC distance on non-weight-bearing tunnel view between the MMPRT and non-MMPRT groups. Moreover, a difference in MTFJ width of 0.665 mm between the affected and contralateral sides was useful in predicting MMPRT. Conclusions The non-weight-bearing tunnel view is useful for the initial diagnosis of MMPRT. Prospective evaluation in a larger population is warranted.

Background Immunodeficient patients are recommended to receive pneumococcal vaccination. However, there is limited evidence showing effectiveness of the polysaccharide vaccine. Polysaccharide vaccination has shown an association with cardiovascular event risk reduction. We assessed the efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in relation to the risk of hospitalization and death due to pneumonia and acute cardiac events. Methods The medical records of all dialysis patients attending our 8 study centers in 2010 were studied, and we selected 1038 consecutive patients. One-to-one propensity score matching was used to correct for potential selection bias in a PPSV23-vaccinated group versus a non-vaccinated group, and a total of 510 patients were identified for outcome analysis. Time to first admission, or deaths due to all-cause pneumonia or cardiac events until 2015 were compared between both groups. Results The all-cause death rate was significantly decreased in the PPSV23-vaccinated group, (hazard ratio [HR] 0.62, 95% confidence interval [CI]; 0.46–0.83, P = 0.002). All-cause death was considered to be a competing risk for the other outcomes. Further outcomes were evaluated by competing risk analysis adjusting for mortality. There was no statistically significant difference in the hospitalization rate for pneumonia; however, the hospitalization rate due to cardiac events was significantly lower in the PPSV23-vaccinated group than in the non-vaccinated group (HR 0.44, 95% CI; 0.20–0.96, P = 0.040). There was no statistically significant difference in the death rate due to pneumonia; however, the rate of cardiac death was significantly lower in the PPSV23-vaccinated group than in the non-vaccinated group (HR 0.36, 95% CI; 0.18–0.71, P = 0.003). Conclusions The PPSV23 vaccination is associated with a good prognosis and a low-risk of cardiac events in dialysis patients; however, there was no evidence indicating enhanced protective efficacy against pneumonia, suggesting the PPSV23 vaccination might improve the prognosis by directly preventing cardiovascular events.

We demonstrated the regenerative amplification of picosecond laser pulses generated by a gain-switched laser diode at 640 nm with a Pr:YLF crystal that was continuously pumped by a multimode blue laser diode. A 0.7-pJ seed pulse energy sufficiently suppressed the self-oscillation in the amplifier. The amplified pulse energy reached 33 µJ at a repetition rate of 10 kHz. The spatial beam quality was nearly T E M 00 . We also demonstrated second- and third-harmonic generation and obtained 320- and 213-nm pulse energies of 18 and 0.83 µJ at 10 kHz.

We experimentally examine the characteristics of a continuous wave Ti:sapphire laser pumped by a 449-nm diode-laser at cryogenic temperatures, including the temperature dependence of the pump laser absorption and the fluorescence efficiency.

High-power picosecond lasers in the visible and ultraviolet wavelength hold a lot of advantages in various applications. The high absorption efficiency in the various metals leads to the higher removal rates, and the shorter pulse widths can suppress thermal influence during the material processing. Recently, the significant progress in the output power of indium gallium nitride (InGaN)-based laser diodes (LDs) has developed the compact high-power lasers which oscillate directly in the visible wavelength. For example, a continuous-wave laser output power of >6.7 W at the fundamental wavelength of 639 nm was reported with a praseodymium-doped LiYF 4 crystal (Pr:YLF) [1]. Moreover, mode-locked picosecond lasers were also reported using a SESAM saturable absorber with Pr:YLF lasers [2,3]. Further scaling of visible picosecond laser pulse requires an amplifier, but only few experiments were reported on the visible laser amplifiers [4]. For example, the maximum amplification factor of 10 was demonstrated at 478 nm [5]. In this paper, a 639-nm picosecond-pulse regenerative amplifier using a Pr:YLF crystal is demonstrated for the first time.

The variation of the electromechanical coupling factor of lead zirconate titanate (PZT) was studied using a piezoelectric PZT disk exposed to a 400 MeV/n xenon beam. The resonant and antiresonant frequencies were measured in pairs by an impedance analyzer in situ manner. A systematic behavior of the pairs resulted in a decrease of the coupling factor. It was found that the coupling factor linearly decreased with increasing integrated beam energy incident on the PZT disk while its surface temperature was equilibrium at room temperature. We discuss a possible PZT-based radiation detector for practical use in a high-radiation field.

We investigated whether P r : Y A l O 3 and P r : Y 3 A l 5 O 12 (YAG) can work as gain media for high-power visible lasers and replace trivalent praseodymium (Pr)-doped fluoride crystals, with particular focus on thermal loading resistivity. P r : Y A l O 3 exhibits a high laser gain at 747 nm, and we obtained a maximum output power of 1.2 W and a slope efficiency of 26.7% with high-power GaN laser diode pumping. Excited state absorption and large phonon energy hinder laser oscillation of Pr:YAG at room temperature. We obtained 616 nm laser oscillation of Pr:YAG at 40 K. Furthermore, we achieved a visible laser with Pr:YAG ceramics for the first time. The maximum output power is ∼ 30 m W with a slope efficiency of ∼ 0.7 % .

We demonstrate a continuous-wave Pr3+:YLF laser pumped by blue laser diodes, and obtain the output power of 6.7 and 3.7 W at 640 and 607 nm, respectively. The Pr3+:YLF laser is extended to passive Q-switching by utilizing a Co2+: MgAl 2 O 4 spinel saturable absorber and its intracavity second harmonic generation at DUV.

We demonstrated the power scaling of a passively Q-switched Pr3+:LiYF4 (YLF) laser at 523, 607, and 640 nm with a Co2+:MgAl2O4 (MALO) saturable absorber and analyzed the experimental results with a numerical simulation based on rate equations. A maximum pulse energy of 33.5 µJ was obtained with a pulse width of 30.9 ns and a repetition rate of 64.0 kHz at 640 nm. We demonstrated ultraviolet pulse generation at 261 and 320 nm by intracavity frequency doubling and obtained 63.3-ns pulses with a pulse energy of 7.0 µJ and a repetition rate of 64.6 kHz at 320 nm as well as 356-ns 261-nm pulses with a pulse energy of 0.2 µJ at a repetition rate of 82.0 kHz. To the best of our knowledge, a 261-nm pulse is the shortest wavelength laser directly generated from the intracavity second-harmonic generation of passively Q-switched lasers.

We demonstrated regenerative laser pulse amplification at 640 nm for the first time, to the best of our knowledge, with a mode-locked Pr3+-doped LiYF4 (Pr3+:YLF) oscillator as a picosecond seed pulse. A regenerative amplifier with a Pr3+:YLF crystal was continuously pumped by a multimode InGaN diode laser. At an absorbed pump power of 3.1 W, we obtained amplified pulse energy of 13 μJ at 10 kHz with an excellent spatial beam quality of M2∼1.1, demonstrated second-harmonic generation, and obtained a 320 nm pulse energy of 5.9 μJ.

Pediatric surgeons currently engage in various abdominal vascular surgeries, which sometimes require vascular conduits or grafts. Herein, we report our experience with patients undergoing vascular reconstruction using a recanalized umbilical vein (rUV) and their long-term outcome. Five patients with extrahepatic portal vein obstruction (EHPVO) underwent mesenterico-/porto-left portal vein (PV) bypass surgery using a short rUV conduit with an interposition vein graft. A sixth neonate with a huge hepatic tumor underwent PV reconstruction with anastomosis of rUV to the proximal PV stump following right hepatectomy with partial PV resection. A seventh patient underwent living donor liver transplantation for recurrent hepatoblastoma. The hepatic inferior vena cava (IVC) was resected because of tumor involvement and reconstructed by transposition of the infrahepatic IVC and interposition of rUV obtained from the donor liver graft. Sufficient flow through rUV was achieved and maintained in all patients without any complications during follow-up (0.7–6.9 years). Esophageal varices, splenomegaly, and other laboratory test abnormalities because of portal hypertension disappeared after surgery in patients with EHPVO. Our experience confirmed the usefulness and long-term patency of rUV as an entry to the intrahepatic PV and as a free vascular graft to reconstruct PV or IVC.

The objective of this study was to construct a finite element model for simulating the mechanical behaviour of a golf club and ball from swing to impact. An experiment using a golf robot was conducted to obtain the motion of the shaft grip during the swing, and the behaviour of the club and ball during the swing and impact. The swing model was developed by inputting the positional coordinate data of the grip, which was obtained from an experiment, into the grip model. The simulation results generally matched the experimental results for the swing motion, the behaviour of the shaft during the swing and the clubhead velocity and orientation at impact. The modelling of the grip contributed to the accuracy of the simulation results by precisely representing swing motion and suppressing the generation of vibration in the shaft grip. This indicates that the components of the proposed modelling method may also be suitable for representing the swing using data obtained from the robot test, and that the model and the approach for modelling may have potential to be used as a predictable tool to supplement robot tests, reducing the dependency on prototypes.

Capillary permeability is a tightly regulated feature of microcirculation in all organ beds. In sepsis, this feature is fundamentally altered. We have previously reported elevated levels of angiopoietin-2 in patients with septic shock, and have investigated tumor necrosis factor (TNF)-related and weak inducer of apoptosis (TWEAK), which mediates both angiogenesis and inflammation, in those patients. Enzyme-linked immunoassay was used to measure serum TWEAK levels in 20 patients with septic shock, all of whom were treated by direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX), and in 20 non-septic controls. The TWEAK levels were higher in patients with septic shock (192.8 ± 230.5 pg/mL) than in controls (84.1 ± 28.7 pg/mL, P = 0.043). Between 11 survivors and 10 non-survivors, there was no significant difference in the serum TWEAK levels before the DHP-PMX therapy. During DHP-PMX therapy, however, the serum TWEAK levels were significantly increased in non-survivors (142.2 ± 88.1 pg/mL to 399.0 ± 307.1 pg/mL, P = 0.022). There was a significant correlation between the serum TWEAK levels and white blood cell counts (r = 0.393, P < 0.001), platelet counts (r = 0.418, P < 0.001), or serum CRP levels (r = 0.259, P = 0.029), but there was no correlation between the serum TWEAK levels and blood pressure. The serum TWEAK levels were also correlated with the ratio of angiopoietin-2 to -1 (r = 0.464, P < 0.001). TWEAK may be a suitable marker of disease severity and mortality in septic patients, and TWEAK levels may be associated with vascular permeability via angiopoietin balance.

We demonstrate the high-power continuous-wave operation of a Pr3+:YLF laser end pumped by blue laser diodes. As the pump source, we used four 5 W single-emitter blue laser diodes and a >20 W fiber-coupled module. In single-emitter-diode pumping, we obtained pump-limited output powers of 6.7 and 3.7 W at 640 and 607 nm, respectively. We successfully suppressed thermal aberration and obtained an output power of 3.4 W at a slope efficiency of 25% at 640 nm with good beam quality in the fiber-coupled module pumping.

Sepsis is characterized by a systemic inflammatory response to a microbial pathogen. In sepsis, capillary permeability is a tightly regulated feature of microcirculation in all organ beds and is fundamentally altered. We investigated the vascular endothelial growth factor (VEGF) level as a vascular permeability factor and the soluble fms-like tyrosine kinase-1 (Flt-1) level as an antagonist of the VEGF receptors. Serum VEGF and soluble Flt-1 levels in 21 patients with septic shock, who were treated with direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX), were measured by enzyme-linked immunoassay. The VEGF and the soluble Flt-1 levels were more elevated in patients with septic shock than in controls. Between 14 survivors and 7 non-survivors, there was no significant difference in VEGF level before the DHP-PMX therapy, but the soluble Flt-1 level of survivors was significantly lower than that of non-survivors. Although there was no significant difference between starting and ending VEGF levels in survivors, in non-survivors the VEGF level at the end of DHP-PMX therapy was significantly lower than that at the start. In survivors, the soluble Flt-1 level at the end of DHP-PMX therapy was significantly lower than that at the start. On the other hand, in non-survivors, there was no significant difference between the ending and starting soluble Flt-1 levels. The soluble Flt-1 level may be a suitable marker of disease severity and mortality.

The presence of myeloid bodies in electron microscopy is a characteristic finding of Fabry's disease. Here, we present a male patient, whose renal biopsy findings suggested the coexistence of focal segmental glomerulosclerosis and Fabry's disease, because of the presence of segmental hyalinosis and/or sclerosis in glomeruli and myeloid bodies in electron microscopy. But finally, Fabry's disease was excluded as a diagnosis because the α-galactosidase A activity in leukocyte and plasma in this patient was within normal limits. After renal biopsy, although he received medication including steroid therapy, his renal function gradually decreased to end-stage renal failure and hemodialysis was initiated. Until now, he does not exhibit any specific symptoms. In conclusion, our case suggests that occasional myeloid bodies in renal biopsy specimens should be interpreted with caution.

Background/Purpose: Congenital absence of the portal vein (CAPV) is a subtype of congenital portosystemic shunt, which can cause a broad spectrum of clinical manifestations. The authors report on 4 patients with CAPV including a boy with CAPV-associated encephalopathy, which was resolved effectively by liver transplantation (LT). Methods: The case records of 4 pediatric patients with CAPV who were referred to the author's institution between 1984 and 1999 were reviewed. Results: The patients (3 boys and 1 girl) ranged in age at diagnosis from 0.8 to 14 years. Two patients had growth retardation or disturbed consciousness, and the other 2 had no specific manifestations. Not only high serum levels of bile acids, ammonia, and transaminases but also low plasma levels of branched-chain amino acids were common laboratory findings. The absent portal vein was replaced by a large portosystemic shunt, which connected the splanchnic vein to the inferior vena cava or the left renal vein. Two patients survived without any symptoms, but 1 with growth retardation died of hepatic failure. The other with encephalopathy did not respond to medical therapy and underwent LT, which resolved symptoms and metabolic disorders effectively. Conclusions: Patients with CAPV do not always have a good prognosis. They should be followed up with careful observation of their symptoms, hepatic function, and metabolic abnormalities. LT might be indicated for patients with symptomatic CAPV unresponsive to medical therapy. J Pediatr Surg 36:1026-1031. Copyright © 2001 by W.B. Saunders Company.

Human parvovirus B19 (HPV B19) infection is well known as a cause of erythema infectiosum in children. Acute glomerulonephritis due to HPVB19 infection is rarely observed in adults. Here, we present the case of a 45-year-old female who showed acute glomerulonephritis induced by HPVB19 infection with various autoantibodies. She had proteinuria (175 mg/g creatinine) and hematuria (20-29 erythrocytes per high-power field) in a urinalysis, and various autoantibodies such as antinuclear antibodies, proteinase-3-antineutrophil cytoplasmic antibodies (PR3-ANCA), antiglomerular basement membrane (GBM) antibodies, and anticardiolipin antibodies in a blood examination. A renal biopsy showed that endocapillary proliferative glomerulonephritis comprised of mononuclear cell infiltration. By using immunofluorescence microscopy, IgG, IgA, IgM, C3, C4, and C1q deposits were detected mainly in glomerular capillaries. Electron-dense deposits were detected in the subendothelial area and mesangial area by using electron microscopy. All symptoms and abnormal laboratory data were self-improved. Our patient's case may provide a clue to the etiology of ANCA-associated vasculitis or lupus nephritis.

Capillary permeability is a tightly regulated feature of microcirculation in all organ beds; however, in sepsis this feature is fundamentally altered. We previously reported elevated levels of vascular endothelial growth factor and its receptor (fms-like tyrosine kinase-1) in patients with septic shock, then investigated two kinds of angiopoietins in those patients. An enzyme-linked immunoassay was used to measure serum angiopoietin-1 and -2 levels in 12 patients with septic shock who were treated by direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX). The angiopoietin-1 level was lower in patients with septic shock (7.01 +/- 10.08 ng/mL) than in controls (28.24 +/- 11.61 ng/mL, P < 0.001), but the angiopoietin-2 level was higher in septic shock patients (40.83 +/- 30.13 ng/mL vs. 2.47 +/- 1.78 ng/mL, P < 0.001). Between seven survivors and five non-survivors there was no significant difference in angiopoietin-1 levels before DHP-PMX therapy. During DHP-PMX therapy, however, the angiopoietin-2 level was significantly decreased in survivors (31.52 +/- 26.15 ng/mL vs. 17.32 +/- 22.46 ng/mL, P = 0.035). Moreover, at the end of the therapy, the angiopoietin-1 level was significantly lower in non-survivors (1.14 +/- 1.30 ng/mL vs. 10.43 +/- 13.56 ng/mL, P = 0.042), but the angiopoietin-2 level in non-survivors was significantly higher (70.79 +/- 40.47 ng/mL vs. 17.32 +/- 22.46 ng/mL, P = 0.019). The angiopoietin-2 level may be associated with vascular permeability in septic patients, and angiopoietins may be suitable markers of disease severity and mortality.

Bacterial superantigens produced by Staphylococcus aureus may be associated with the onset of proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA)-associated vasculitis, including Wegener's granulomatosis. We investigated T-cell subsets to assess the superantigens present in patients with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis.Peripheral-blood mononuclear cells (PBMC) obtained from 40 normal controls and ten patients with MPO-ANCA-associated vasculitis were stained with fluorescence-labeled monoclonal antibodies against T-cell markers, including 17 variable regions of T-cell receptor beta-chains (TCR-Vbeta) and were then analyzed using flow cytometry.Among PBMCs, the percentage of CD3(+) cells from patients with MPO-ANCA-associated vasculitis was significantly lower than that from normal controls, but there were no differences between the two groups in the percentage of CD19(+) cells or CD16(+) cells. Although there were no differences regarding the overall percentage of CD4(+) cells between the two groups, the percentage of CD4(+)CD45RO(+) cells in patients with MPO-ANCA-associated vasculitis was significantly higher than that in normal controls, and percentages of CD4(+)CD45RO(+)HLA-DR(+) and CD4(+)CD45RO(+)CD62L(low) cells in patients with MPO-ANCA-associated vasculitis were also significantly increased. There was no significant difference between the two groups in terms of the usage of the 17 different TCR-Vbeta regions.There was no difference in bacterial superantigens between controls and MPO-ANCA-associated vasculitis patients because of the absence of specific usage of TCR-Vbeta regions. Given the elevated levels of memory T cells, conventional antigens rather than superantigens may be associated with the pathogenesis of MPO-ANCA-associated vasculitis.

Purpose The authors evaluated the validity of the Pediatric End-Stage Liver Disease (PELD) Risk Scoring System as a severity index for patients with biliary atresia. Methods Individual hospital records of 104 patients with biliary atresia were reviewed at our institution and divided into 3 groups: nontransplant survivors (n = 61), nontransplant deaths (n = 17), and transplant patients (n = 26). PELD risk scores were calculated according to Wiesner et al, multiplied by 10, and rounded to the nearest integer, as is done in determining model of end-stage liver disease (MELD) scores. Results The PELD scores showed a significant difference between nontransplant survivors (range, −21 to 15) and dying nontransplant patients during their last few months of life (range, 2 to 40). No survivors except those below the age of one year recorded scores above 10. Transplant patients had higher scores (range, −5 to 37) before transplantation than nontransplant survivors. However, the scores were not elevated in elderly patients with intractable cholangitis, fulminant variceal rupture, and hepatopulmonary syndrome. Conclusions PELD profiling is a useful scoring system for selecting patients with the most severe liver dysfunction caused by biliary atresia. However, we advise caution in using this system for patients under the age of 1 year and for older patients with long-term complications.

The efficiency of the so-called econovent heat exchanging equipment located in the Institute of Laboratory Animal Sciences, Faculty of Medicine, Kagoshima University, was measured as follows: The air velocity was decreased to about 64% of that with the fresh air ducts, but a sufficient air volume was supplied maintaining an air change of 12 times per hour or more. The efficiency of the econovent showed a little difference depending upon air conditioning systems. The average efficiencies were 81%, 75% and 76% for temperature, absolute humidity and enthalpy, respectively. The energy required for the air conditioning in this facility in September 1975 and January 1976 estimated by enthalpy hour almost agreed with that estimated using a calorie meter or steam meter. It was assumed that a total of 63% and 60% energy were saved in the cooling and heating seasons, respectively, using the econovent.

Twenty-six out of fifty pregnant rats died on days 18-20 of gestation at 33 degrees C environment. The death generally occurred in the dark period around 1-5 a.m. Shortly prior to the death, very high body temperature of 42.0-43.7 degrees C were recorded and the blood pressure was undetectably low. In autopsy, the finding in the main was the congestion in lungs and liver. In temporal changes of body temperature and heart rate, influences of hot environment were observed, but there was no significant difference between dead pregnant group and delivered pregnant group at 33 degrees C environment. At 23 degrees C, the blood pressure of pregnant rats starting at about 140 mmHg level, reached 160-168 mmHg on day 12 of gestation and maintained the level to day 16. On day 18, the pressure returned to 140-145 mmHg and unchanged to term. At 33 degrees C, significant differences were obviously observed between dead group and delivered group in temporal changes of blood pressure. The blood pressure of rats delivered sharply increased to 170 mmHg or more in the middle stage of pregnancy and decreased to about 140 mmHg in the final stage. However, these of dead group increased to 160 mmHg or less in the middle stage of pregnancy, and maintained the level until the final stage.

The relation between blood pressure and delivery in pregnant rats was investigated when the blood pressure of pregnant rats was controlled by a pressor or antihypertensive drug in the middle or final stage of pregnancy. All of the pregnant rats studied delivered in a 23 degrees C environment in spite of blood pressure control by a pressor or antihypertensive drug. At 33 degrees C, the pregnant rats were divided into two groups whose blood pressure was increased severely (160-175 mm Hg) or moderately (145-155 mm Hg) at 10 days of pregnancy. Those in the former group delivered, but those in the latter died in the final stage of pregnancy. When the pregnant rats in the group with high blood pressure on day 10 were treated with a antihypertensive drug in the middle stage of pregnancy or with a pressor drug in the final stage, the mortality rate was 100 per cent in both cases. The delivery rate was 57 per cent when the pregnant rats were treated with a antihypertensive drug from the middle to the final stage of pregnancy. In the group with low blood pressure on day 10, all of the pregnant rats delivered when they were treated with a pressor drug in the middle stage of pregnancy. However, the delivery rate was 89 per cent when the pregnant rats were treated with antihypertensive drug in the final stage of pregnancy.

We present a detailed characterization of Cr4+ and C02+ -doped oxides as saturable absorbers for the visible spectral region. The first visibly emitting Q-switched laser utilizing a C02+: Gd 3 Gas012 saturable absorber is demonstrated.