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Background On the basis of findings of observational studies and a meta-analysis, proteinuria reduction has been proposed as a surrogate outcome in IgA nephropathy. How long a reduction in proteinuria needs to be maintained to mitigate the long-term risk of disease progression is unknown. Methods In this retrospective multiethnic cohort of adult patients with IgA nephropathy, we defined proteinuria remission as a $25% reduction in proteinuria from the peak value after biopsy, and an absolute reduction in proteinuria to,1 g/d. The exposure of interest was the total duration of first remission, treated as a time-varying covariate using longitudinal proteinuria measurements. We used time-dependent Cox proportional hazards regression models to quantify the association between the duration of remission and the primary outcome (ESKD or a 50% reduction in eGFR). Results During a median follow-up of 3.9 years, 274 of 1864 patients (14.7%) experienced the primary outcome. The relationship between duration of proteinuria remission and outcome was nonlinear. Each 3 months in sustained remission up to approximately 4 years was associated with an additional 9% reduction in the risk of disease progression (hazard ratio [HR], 0.91; 95% confidence interval [95% CI], 0.89 to 0.93). Thereafter, each additional 3 months in remission was associated with a smaller, nonsignificant risk reduction (HR, 0.99; 95% CI, 0.96 to 1.03). These findings were robust to multivariable adjustment and consistent across clinical and histologic subgroups. Conclusions Our findings support the use of proteinuria as a surrogate outcome in IgA nephropathy, but additionally demonstrate the value of quantifying the duration of proteinuria remission when estimating the risk of hard clinical endpoints. Copyright © 2021 by the American Society of Nephrology.

Objectives This study sought to derive age-, sex-, and ethnic-appropriate adult reference values for left atrial (LA) and left ventricular (LV) dimensions and volumes, LV mass, fractional shortening, and ejection fraction (EF) derived from geographically diverse population studies. Background The current recommended reference values for measurements from echocardiography may not be suitable to the diverse world population to which they are now applied. Methods Population-based datasets of echocardiographic measurements from 22,404 adults without clinical cardiovascular or renal disease, hypertension, or diabetes were combined in an individual person data meta-analysis. Quantile regression was used to derive reference values at the 95th percentile (upper reference value [URV]) and fifth percentile (lower reference value [LRV]) of each measurement against age (treated as linear), separately within sex and ethnic groups. Results The URVs for left ventricular end-diastolic volume (LVEDV), LV end-systolic volume, and LV stroke volume (SV) were highest in Europeans and lowest in South Asians. Important sex and ethnic differences remained after indexation by body surface area or height for these measurements, as well as for the LRV for SV. LVEDV and SV decreased with increasing age for all groups. Importantly, the LRV for EF differed by ethnicity; there was a clear apparent difference between Europeans and Asians. The URVs for LV end-diastolic diameter and LV end-systolic diameter were higher for Europeans than those for East Asian, South Asian, and African people, particularly among men. Similarly, the URVs for LA diameter and volume were highest for Europeans. Conclusions Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.

An alloy semiconductor Si 1− x Ge x ( x ~0.5) crystal was grown by the TLZ method in microgravity. Ge concentration was 48.5±1.5 at% for the whole region of 10 mm diameter and 17.2 mm long crystal. Compositional uniformity was established but the average concentration was a little deviated from the expected 50 at%. For further improving compositional uniformity and for obtaining Si 0.5 Ge 0.5 crystals in microgravity, growth conditions were refined based on the measured axial compositional profile. In determining new growth conditions, difference in temperature gradient in a melt, difference in freezing interface curvature, and difference in melt back length of a seed between microgravity and terrestrial growth were taken into consideration.

Unique properties of the N-acceptor in homo- and hetero-epitaxially grown ZnO by molecular beam epitaxy (MBE) are studied by means of microproving of surface sheet-resistance, Hall-effect measurement, persistent photoconduction (PPC) and thermally stimulated current (TSC). Rapid postanneal of N-doped ZnO is found to induce the change in the conduction type from n-type (as-grown) to p/n-type mixed conduction, forming island structure, and these properties are related to a structural instability of the N-acceptor.

To investigate the relation between aortic stiffness and coronary flow reserve (CFR) in patients with coronary artery disease (CAD).Observational study.Coronary care unit of a primary care hospital.192 consecutive patients who underwent coronary angiography.Brachial-ankle pulse wave velocity (ba-PWV), CFR, and severity of CAD.According to the angiographic findings, patients were divided into four subgroups: patients without significant stenosis (normal coronary artery (NCA) group, n = 28) and those with one vessel disease (1VD group, n = 92), two vessel disease (2VD group, n = 50), or three vessel disease (3VD group, n = 22). ba-PWV increased with the number of diseased vessels and was significantly correlated with the number of diseased vessels (NCA group v 1VD group v 2VD group v 3VD group: 1481 (252) v 1505 (278) v 1577 (266) v 1727 (347) cm/s, p0.001). CFR had a significant negative correlation with ba-PWV (r = -0.45, p0.0001). The diastolic to systolic velocity ratio obtained in 45 patients also was significantly correlated with ba-PWV (r = -0.35, p0.05). Multiple regression analysis showed that ba-PWV was an independent determinant of CFR (p0.01).Coronary flow is altered with aortic stiffening in patients with CAD. These results suggest one possible mechanism for recent reports that aortic stiffness is a key cardiovascular risk factor.

Background: It is well known that angiotensin converting enzyme (ACE) inhibitors and angiotensin II type 1 (AT1) receptor blockers (ARBs) prevent left ventricular (LV) remodelling after myocardial infarction (MI). However, it is still not clear whether inhibition of the AT1 receptor is enough to prevent LV remodelling after MI. Objective: To elucidate the effects of ACE inhibitors that are not mediated by the AT1 receptor on LV remodelling, MI was experimentally induced in wild-type (WT-MI) mice and AT1 receptor knockout (KO-MI) mice. Methods: Mice were divided into six groups: WT-control, KO-control, WT-MI, KO-MI, WT-MI treated with an ACE inhibitor, and KO-MI treated with an ACE inhibitor. Four weeks after MI, cardiac function was assessed by Doppler echocardiography and non-infarcted myocardial mRNA expression by northern blot analysis. Results: Cardiac function decreased significantly in the MI groups compared with the sham operated groups. Additionally, in the MI groups end diastolic dimension, E wave velocity, the ratio of peak velocity of E wave to A wave, deceleration rate of E wave, and mRNA expression of atrial natriuretic peptide, brain natriuretic peptide, and collagens I and III increased significantly compared with the sham groups. LV remodelling after MI was prevented in KO-MI mice compared with WT-MI mice. ACE inhibitor administration significantly attenuated progressive LV remodelling in both WT and KO-MI groups. Conclusion: ACE inhibitors can prevent the LV remodelling process that accompanies cardiac dysfunction after MI, even in AT1 KO mice. These findings suggest that ACE inhibitors prevent LV remodelling after MI by mechanisms other than inhibition of angiotensin AT1 receptor mediated effects.

Objectives: To clarify the value of cycle dependent variation of myocardial integrated backscatter (CV-IB) analysis, which non-invasively measures acoustic properties of the myocardium, for early detection of cardiac involvement in patients with sarcoidosis. Methods: The study population consisted of 22 consecutive patients with biopsy proven sarcoidosis who did not have any abnormal findings on conventional two dimensional echocardiogram. Cardiac sarcoidosis was diagnosed by radionuclide testing including thallium-201 scintigraphy, gallium-67 scintigraphy, and cardiac fluorine-18-deoxyglucose positron emission tomography. The magnitude and delay of the CV-IB were analysed in the basal mid septum and the basal mid posterior wall of the left ventricle of all patients. Results: The patients were divided into two groups: 8 patients with cardiac involvement and 14 patients without cardiac involvement. In the basal septum, a major reduction in the magnitude (mean (SD) 1.8 (4.4) v 6.6 (1.3), p = 0.012) and an increase in the time delay (1.3 (0.5) v 1.0 (0.1), p = 0.038) of CV-IB were observed in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. The sensitivity for detecting cardiac involvement was such that the magnitude of CV-IB in the basal septum discriminated 75% of patients with cardiac sarcoidosis from those with non-cardiac sarcoidosis, whereas two dimensional echocardiographic parameters did not discriminate between these two groups. Conclusions: The CV-IB is decreased in the basal septum in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. Analysis of CV-IB may be a useful method to detect early myocardial involvement in patients with sarcoidosis.

To investigate whether concentrations of plasma adiponectin constitute a significant coronary risk factor, with particular focus on the relation between plasma concentrations of adiponectin and the development of acute coronary syndrome (ACS).Plasma concentrations of adiponectin were measured in 123 patients with coronary artery disease (CAD) and in 17 control participants. Patients were divided into three groups according to condition type: acute myocardial infarction (AMI) group (n = 59), unstable angina pectoris (UAP) group (n = 28), and stable angina pectoris (SAP) group (n = 36).Plasma concentrations of adiponectin correlated negatively with body mass index (r = -0.18, p0.05), serum triglyceride (r = -0.25, p0.01), and fasting glucose concentrations (r = -0.21, p0.05), but correlated positively with age (r = 0.26, p0.01), high density lipoprotein cholesterol concentrations (r = 0.35, p0.01), and low density lipoprotein particle size (r = 0.37, p0.01). Plasma concentrations of adiponectin in patients with ACS, in both the AMI and UAP groups, were significantly lower than those in patients with SAP and in the control group (ACS, 6.5 (3.0) microg/ml; SAP, 11.3 (5.9) micro g/ml; control 12.8 (4.3) microg/ml; p0.01). Additionally, plasma concentrations of adiponectin in patients with CAD (7.9 (4.6) microg/ml, p0.01) were significantly lower than in the control group. There were, however, no significant differences between patients with SAP and the control group (p = 0.36). Multiple logistic regression analysis showed that smoking, fasting glucose concentration, and low log adiponectin concentration correlated independently with the development of an ACS.The findings suggest that measurement of plasma concentrations of adiponectin may be of use for assessing the risk of CAD and may be related to the development of ACS.

Objective: To evaluate the acute effects on haemodynamic variables of biatrial pacing in comparison with high right atrial (HRA) pacing and left lateral atrial pacing. Patients and design: 23 patients were paced from the HRA site, the lateral site of the coronary sinus (CS), and both sites on two fixed atrioventricular delays (100 and 150 ms) during atrioventricular sequential pacing at 80 and 100 beats/min in random order. Main outcome measures: After five minute pacing, the maximum P wave duration on a 12 lead ECG, cardiac output, pulmonary capillary wedge pressure, and the transmitral flow pattern by transthoracic echocardiography were measured. Results: Biatrial pacing delivered the shortest P wave duration (133 (25) ms, 133 (27) ms, and 96 (15) ms during HRA, CS, and biatrial pacing, respectively; p < 0.001), and the most improvement in cardiac output and pulmonary capillary wedge pressure (3.71 (0.93) l/min and 15 (7) mm Hg, 3.79 (0.97) l/min, and 14 (6) mm Hg, and 4.09 (1.01) l/min and 13(6) mm Hg during HRA, CS, and biatrial pacing, respectively; p < 0.01). Biatrial pacing most significantly decreased the intervals between the atrial pacing spike and the peak and end of the atrial filling wave (186 (16) ms and 250 (22) ms, 172 (19) ms and 242 (24) ms, and 153 (15) ms and 227 (23) ms during HRA, CS, and biatrial pacing, respectively; p < 0.001). It also significantly increased the mitral flow time velocity integral and peak atrial filling wave velocity (7.5 (3.4) cm and 63.8 (17.6) cm/s, 7.8 (3.0) cm and 62.4 (16.6) cm/s, and 8.3 (3.4) cm and 67.8 (19.3) cm/s during HRA, CS, and biatrial pacing, respectively; p < 0.05). The improvements in haemodynamic variables were especially remarkable in patients who had a longer interatrial conduction delay. Conclusions: Biatrial pacing yielded the most significant improvements in haemodynamic variables. These haemodynamic benefits may play a part in reducing intra-atrial pressure and preventing atrial fibrillation.

We investigated the effects of the aldosterone blocker eplerenone alone and in combination with angiotensin II type 1 receptor antagonist on ventricular remodeling in rats with left ventricular (LV) dysfunction after extensive myocardial infarction (MI). Adding an aldosterone antagonist to an ACE inhibitor reduces mortality and morbidity in heart failure. Starting 1 day after MI, rats were treated with placebo, eplerenone (100 mg/kg/day), the angiotensin type 1 receptor antagonist candesartan (1 mg/kg/day), or a combination of both for nine weeks. Both monotherapies attenuated the rise in LV end-diastolic dimension (LVDd) and LV end-diastolic volume (LVEDV) compared with placebo, whereas combined treatment further attenuated LVDd and LVEDV and significantly improved LV function. Increased collagen type I and III gene expressions in the noninfarcted LV myocardium from MI placebo rats was attenuated by candesartan, but almost completely prevented by eplerenone and eplerenone/candesartan. The addition of eplerenone to candesartan prevented the increases in LV gene expression of ANP and BNP more effectively than either monotherapy. The aldosterone blocker eplerenone improved LV remodeling in rats with LV dysfunction after extensive MI. Combination therapy with an candesartan substantially potentiates this effect by a complementary prevention of LV fibrosis, cardiac hypertrophy, and molecular alterations.

Objective: To evaluate the feasibility of quantifying low temperature radiofrequency catheter ablation (RFCA) lesions using a phased array intracardiac echocardiography (ICE) catheter—with better tissue penetration and in a deflectable device—in the canine model. Intervention: Low temperature radiofrequency (RF) energy (50–60°C at up to 40 W) was delivered to the left ventricle in 11 beagles for 60 seconds, using an 8 French catheter with a deflectable tip and a 4 mm distal electrode. Main outcome measures: Comparison of the width and depth of RFCA lesions measured by ICE with pathological findings. Results: 33 RF energies were delivered in 11 dogs. 31 lesions (94%) were confirmed at necropsy. 27 of 31 ablation lesions (87%) were detected by ICE. The mean (SD) width and depth of the ICE detected lesions were 10.4 (2.6) mm and 5.7 (1.9) mm, respectively. Pathological findings showed that RFCA lesions consisted of inner and outer layers. Macroscopically, the mean (SD) width and depth of the inner layers were 7.6 (2.3) mm and 3.6 (1.2) mm and those for the whole layers were 10.0 (2.8) mm and 5.3 (1.5) mm, respectively. Microscopically, the inner and outer layers corresponded to necrotic and oedematous areas, respectively. The ICE detected lesion size had better correlation with the pathological measurements of the whole layers in width (r = 0.911) and in depth (r = 0.756). Conclusion: The real time evaluation of RFCA lesion size using the phased array ICE is feasible, even with a low temperature RF application. However, ICE slightly overestimates RFCA lesion size compared with pathological necrotic lesion size.

The prevalent theory concerning the pathogenesis of chronic obstructive pulmonary disease (COPD) is of an imbalance between oxidants and antioxidants in the lung. It has recently been reported that the production of peroxynitrite, an extremely potent oxidant, is increased in the airways of patients with COPD. A study was undertaken of the imbalance between the levels of nitrogen oxides and antioxidant activity against peroxynitrite in the airways of patients with COPD.Sputum induction was performed in 30 patients with COPD and 15 normal control subjects. Levels of nitrogen oxides, percentage of neutrophils, and interleukin 8 (IL-8) levels were measured in sputum samples, and peroxynitrite inhibitory activity was assayed by monitoring rhodamine formation.Nitrite and nitrate levels in induced sputum were significantly higher in patients with COPD than in normal controls (949 (133) microM v 621 (89) microM, p0.001). In contrast, peroxynitrite inhibitory activity in induced sputum was significantly lower in patients with COPD than in normal controls (47.4 (12.7)% v 92.9 (3.9)%, p0.001). There was a negative correlation between nitrite and nitrate levels and peroxynitrite inhibitory activity in induced sputum (r=-0.775, p0.001). Peroxynitrite inhibitory activity was also significantly correlated with forced expiratory volume in 1 second (FEV(1)) % predicted (r=0.539, p=0.004), FEV(1)/FVC (r=0.512, p=0.006), and carbon monoxide transfer factor (TLCO) (r=0.486, p=0.009). Moreover, there was a significant negative correlation between peroxynitrite inhibitory activity and the degree of neutrophilic inflammation (percentage of neutrophils: r=-0.754, p0.001; IL-8 levels: r=-0.497, p=0.007).Reduced peroxynitrite inhibitory activity and increased levels of nitrogen oxides are found in induced sputum from patients with COPD. An imbalance in nitrogen oxides and antioxidant defence may contribute to the pathogenesis of COPD.

There is evidence that the bronchial microcirculation has the potential to contribute to the pathophysiological mechanisms of exercise induced bronchoconstriction (EIB) in asthmatic subjects. Vascular endothelial growth factor (VEGF), which is highly expressed in asthmatic airways, increases vascular permeability. The relationship between VEGF levels in induced sputum and the severity of EIB in asthmatic subjects was studied.The concentration of VEGF in induced sputum was examined in 23 asthmatic subjects and 11 normal controls. The asthmatic subjects performed an exercise test and the % maximal fall in forced expiratory volume in 1 second (FEV(1)) was measured. Beclomethasone dipropionate (BDP) 400 micro g twice daily was administered to the asthmatic subjects for 8 weeks and the exercise test and sputum induction were repeated.The concentration of VEGF in induced sputum was significantly higher in asthmatic subjects than in normal controls. There was a significant correlation between the concentration of VEGF and the % maximal fall in FEV(1) (r=0.826, p=0.0001) and between the concentration of VEGF and airway vascular permeability index (r=0.621, p=0.0037). After treatment with inhaled BDP there was a significant decrease in the concentration of VEGF in the asthmatic subjects (before treatment: 7051 (2361) pg/ml, after treatment: 4498 (2135) pg/ml, p0.0001). The change in the concentration of VEGF was significantly correlated with the change in the % maximal fall in FEV(1) (r=0.463, p=0.031).Excessive production of VEGF in asthmatic airways may contribute to the pathogenesis of EIB via increased airway vascular permeability.

The temperature dependence of ESR in InP : Er and the O2 codoping effect in InP : Er have been studied by X-band ESR measurement at low temperature. The ESR at around g=6, which corresponds to Er3+ site with Td symmetry, lost it's intensity quickly as the temperature is increased and disappeared above 12 K . The temperature dependence of the integrated intensity turned out to be different from simple Curie law. The intensity of the ESR at around g=6 decreased as O2 is codoped into InP : Er . No new ESR was observed in O2 codoped InP : Er in contrast to the results of O2 codoped GaAs : Er . These results are discussed in connection with the O2 codoping effect of photoluminescence spectra.

Cyclotron resonance (CR) measurements of heavily doped Si : Mn prepared by chemical vapour deposition have been performed at 4.2 K by our high field CR measurement system equipped with a UV light illumination. The system is equipped with a pulsed magnetic field up to 16 T and light sources from 30 GHz to 700 GHz. The field dependence of the effective masses and linewidths of CRs at 4.2 K are discussed in connection with those observed by a conventional X-band ESR measurement system at 3.4 K under UV light illumination.

Differences in spatial distribution and abundance of bud galls caused by eriophyoid mites (Acari: Eriophyoidea) among Carpinus tschonoskii (Betulaceae) were studied. This mite preferentially induces galls on terminal buds. Four factors influencing gall abundance were examined: host tree size, host tree's reproductive status, altitude and study site. As tree size increased, the number of galls increased to an apparent asymptote. This result suggests that tree size-dependent characteristics such as number of terminal buds, temporal pattern of shoot elongation and reproductive status influence gall abundance.

To determine the anatomy of the portal venous system in the posterior aspect of segment IV of the liver by using helical computed tomography (CT) during arterial portography (CTAP).One hundred consecutive patients underwent CTAP. Helical CT during hepatic arteriography was performed in 20 patients. In seven patients with hepatocellular carcinoma in the posterior aspect of segment IV, the feeding arteries were also analyzed.A venule from the intrahepatic portal vein to segment IV was seen in all patients. Other findings included a tiny venule from the distal part of the main left portal vein (n = 36), from the proximal left main portal vein (n = 20), and from the right portal vein (n = 18). Aberrant right gastric venous drainage and/or parabiliary venous drainage directly into the posterior aspect was present in 14 patients. In two patients, a tiny accompanying artery was seen on images from CT during hepatic arteriography. In seven patients with hepatocellular carcinoma, the main feeding artery branched from the right (n = 2) or left (n = 5) hepatic artery.CTAP adequately demonstrates the tiny portal venous and arterial branches from the main right or left portal vein that distribute to the posterior aspect of segment IV. Knowledge of this vascular anatomy is clinically important.

Background: Aberrant gastric venous drainage (AGVD) into the posterior edge of the medial segment of the liver (segment IV) is the main cause of pseudolesion on computed tomography (CT) during arterial portography. We estimated the prevalence of AGVD into the medial segment of the liver with color and power Doppler ultrasound (US).

BACKGROUND Macrophage scavenger receptor (SR) is implicated in playing a key role in macrophage-derived foam cell formation by taking up a large amount of modified low-density lipoproteins (LDL). It has also been postulated that alpha 2-macroglobulin receptor/LDL receptor-related protein (alpha 2MG/LRP) is involved in the development of foam cells by taking up apo E-enriched chylomicrons and VLDL remnants, and lipoprotein lipase-triglyceride-rich lipoprotein complexes. Accumulation of these lipid-loaded monocyte/ macrophages in the subendothelial space is considered to be an early event of atherogenesis. Since atherogenesis is considered to be accelerated in dialysis patients, we attempted to investigate whether gene expression of SR and alpha 2MG/LRP are altered in peripheral blood monocytes from patients on haemodialysis with a cuprophane (Cu) or polymethylmethacrylate (PMMA) membranes. METHODS Peripheral blood monocytes (PBM) were prepared from patients undergoing haemodialysis with a Cu membrane (n = 9), patients undergoing haemodialysis with a PMMA membrane (n = 9), and healthy controls (n = 7). In a separate experiment we examined SR gene expression in uraemic patients (n = 12) and healthy controls (n = 9). SR and alpha 2MG/LRP mRNA were semiquantitated using reverse-transcription polymerase chain reaction (RT-PCR) assay followed by Southern blotting. RESULTS SR mRNA expression in PBM from patients on chronic haemodialysis with a Cu membrane was about twofold higher than that in PBM from patients on chronic haemodialysis with a PMMA membrane or the controls (P < 0.05). alpha 2MG/LRP mRNA expression in PBM showed no difference among these, three groups. SR gene expression in monocytes from uraemic patients was not increased compared with that in the controls. CONCLUSION PBM from patients under Cu membrane dialysis showed higher gene expression of SR than patients under PMMA membrane dialysis, uraemic patients, or healthy controls. This increased gene expression of SR in monocytes may be associated with the pathogenesis of accelerated atherosclerosis in patients on dialysis with a Cu membrane.

To analyze the frequency and number of suspected peribiliary cysts in cirrhotic liver on computed tomography (CT).Three hundred forty-six cases with clinically diagnosed liver cirrhosis (LC) and 307 cases with clinically diagnosed non-LC were subjected to the study. The frequency and number of suspected peribiliary cysts on CT were compared between the two groups. The existence of peribiliary cysts was suggested when a cyst was observed around the second- to fourth-order branches of the intrahepatic portal vein.Peribiliary cysts were suggested on CT in 31 of 346 cirrhotic livers (9.0%) and 10 of 307 noncirrhotic livers (3.3%). This difference in the frequency of peribiliary cysts was statistically significant (chi2, p0.01). Multiple peribiliary cysts were seen in 71% of cirrhotic patients with peribiliary cyst. The size of peribiliary cysts was smaller than 1.5 cm in diameter.Peribiliary cyst is radiologically observed more frequently in cirrhotic liver than in noncirrhotic liver and is occasionally multiple.

One of the most common sites of focal sparing in fatty livers (focal spared area) shown by sonography or CT is the posterior edge of segment IV. The differentiation of such a focal spared area from tumor has been a diagnostic challenge. The purpose of this study was to determine if a correlation exists between the focal spared area at the posterior edge of segment IV in fatty liver and the decrease of portal perfusion from the main portal vein due to aberrant gastric venous drainage directed into segment IV.Seventeen patients with fatty liver diagnosed on the basis of sonographic and CT findings who had hepatic arteriography and/or CT during arterial portography (CTAP) were included in the study. Seven patients had a focal spared area more than 2 cm in the longest diameter at the posterior edge of segment IV, and 10 patients did not have a focal spared area. The frequency of aberrant gastric venous drainage shown by arteriography (17 patients) and/or by CTAP (15 patients) was compared in the two groups of patients.Hepatic arteriography showed aberrant gastric venous drainage in all patients who had a spared area, and CTAP showed a portal perfusion defect at the posterior edge of segment IV in all five patients with a focal spared area who underwent CTAP. On the other hand, no definite aberrant gastric venous drainage and portal perfusion defect were seen in any patient without a spared area. The difference in the frequency of aberrant gastric venous drainage between the two groups of patients was statistically significant (chi-square test, p.0001).Our results show that a strong correlation exists between the focal spared area at the posterior edge of segment IV in fatty liver and aberrant gastric venous drainage directed to segment IV. Focally decreased blood flow from the main portal vein associated with aberrant gastric venous drainage is a likely cause of the focal spared area. This fact is important for the differential diagnosis of hepatic tumors.

PURPOSE: To evaluate the changes in surrounding liver parenchyma after treatment of hepatocellular carcinoma (HCC) and borderline malignant lesions with percutaneous ethanol injection (PEI). MATERIALS AND METHODS: The authors reviewed the findings at computed tomography (CT) and CT during arterial portography (CTAP) obtained before and after PEI therapy for 32 lesions in 26 patients with HCC or adenomatous hyperplasia. Two surgically resected specimens were also histologically examined. RESULTS: In 10 (77%) of 13 lesions, decreased portal vein-related enhancement indicative of reduced portal blood flow in the periphery of the tumor was found at CTAP. Mild atrophy (concave liver surface), segmental atrophy, and lobar atrophy were found in 40%, 17%, and 3%, respectively. Histologic examination of the resected specimens revealed organized thrombi in the peripheral portal vein in the surrounding liver. CONCLUSION: PEI may cause decreased portal blood flow and atrophy in the noncancerous liver parenchyma that ...

Background: We have previously shown that angiotensin converting enzyme (ACE) DD genotype is associated with exaggerated pulmonary hypertension and disturbance of tissue oxygenation during exercise in patients with chronic obstructive pulmonary disease (COPD). A pilot study was designed to examine the effects of captopril on these exercise related variables in COPD patients categorised according to ACE gene polymorphisms. Methods: Thirty six patients with COPD (II=13, ID=11, DD=12) received oral captopril (25 mg) or placebo in a randomised, double blind, crossover manner and underwent right heart catheterisation with exercise. Results: Mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and lactate concentration after exercise with both placebo and captopril were higher in patients with the DD genotype than in those with the II or ID genotypes. In contrast, mixed venous oxygen tension (Pvo 2 ) was lower in patients with the DD genotype than in those with the other genotypes. Moreover, mPAP, PVR, and lactate concentration after exercise were lower in the captopril group than in the placebo group in patients with the II or ID genotype, but not in those with the DD genotype. Pvo 2 after exercise was higher with captopril than with placebo in patients with the II genotype, but not in those with the other genotypes. Conclusions: These findings suggest that pulmonary haemodynamic variables and state of tissue oxygenation during exercise are dependent on ACE genotypes, and that captopril administration effectively influences these exercise related variables. Although the sample size in this pilot study was limited, it is likely that the improvement in exercise related variables in COPD patients with the II genotype is relatively sensitive to captopril.

To evaluate the causes of intrahepatic segmental areas of signal hypointensity [corrected] on T1- and T2-weighted spin-echo (SE) and gradient-echo (GRE) magnetic resonance (MR) images.Six patients in whom wedge-shaped hypointense areas were seen on hepatic MR images underwent examination with ultrasound (US), computed tomography (CT), angiography, and CT during arterial portography (CTAP). Histologic examination was performed in three patients.The affected liver parenchymas were best depicted as segmental or lobar hypointense areas on GRE images. Angiography and CTAP revealed that portal blood supply to the hypointense areas was absent or decreased due to portal vein tumor thrombus and arterioportal shunt (n = 1), compression of a portal branch by tumor (n = 2), portal vein thrombosis (n = 1), or arterioportal shunt (n = 2). Iron deposition in the hepatocytes was evident in all three patients with histologic correlation.Segmental signal hypocoagulability was generally due to hepatocyte iron deposition and was accompanied and possibly caused by a disturbance in portal flow.

To compare the efficacy of fat-suppressed T1-weighted magnetic resonance (MR) imaging and dynamic MR imaging in the diagnosis of small pancreatic adenocarcinomas.Pancreatic adenocarcinomas in 15 patients were evaluated with dynamic computed tomography (CT) and five MR imaging sequences that included fat-suppressed T1-weighted technique and dynamic multiplanar gradient-recalled acquisition in the steady state technique.The difference in contrast-to-noise ratios between tumor and normal pancreas was significantly different (P.05) between the five MR imaging sequences used. In six patients, the combination of dynamic MR imaging and fat-suppressed imaging was superior to dynamic CT in the detection of tumors. Tumors accompanied by chronic pancreatitis were less distinct on fat-suppressed images but were clearly visible on dynamic MR images. Peripancreatic extension of tumors was better recognized on T1-weighted images and CT scans than on fat-suppressed images.Fat-suppressed T1-weighted images and dynamic MR images were useful in the detection of pancreatic carcinomas. T1-weighted images and CT scans were superior in the evaluation of tumor extension.

To retrospectively evaluate computed tomographic (CT) findings of immunoglobulin G4 (IgG4)-related disease involving the vascular system.This study was approved by the institutional review board, and all patients included had consented to the use of their medical records for the purpose of research. The study consisted of 17 patients (16 men and one woman; age range, 54-86 years). CT findings of IgG4-related periarterial lesions were retrospectively analyzed. Radiopathologic correlations were examined on the basis of surgically resected specimens.A total of 22 periarterial lesions were detected in 17 patients. The lesions were located in the thoracic aorta (n = 4), abdominal aorta to iliac arteries (n = 13), superior mesenteric artery (n = 3), inferior mesenteric artery (n = 1), and splenic artery (n = 1). Radiologically, they were characterized by arterial wall thickening (mean thickness, 11 mm), relatively clear circumscription, possible association with luminal change (mostly dilated and rarely stenotic), exaggerated atherosclerotic change, and homogeneous enhancement at the late phase of contrast material-enhanced CT. Twelve patients (71%) had IgG4-related disease in other organs. Pathologically, diffuse lymphoplasmacytic infiltration, numerous IgG4-positive plasma cells, and irregular fibrosis were noted in the thickened arterial wall, especially at the adventitia. Steroid therapy administered to eight patients rapidly diminished the arterial wall thickening. One patient who did not receive steroid therapy showed spontaneous improvement at follow-up CT.IgG4-related arterial lesions occur mainly in the aorta and its main branches and are radiologically characterized by homogeneous arterial wall thickening corresponding to pathologic features of IgG4-related sclerosing inflammation in the adventitia.

Cluster states are sufficient resources for realizing quantum computation. Their implementations can be achieved via either discrete‐variable systems (especially qubit systems) or continuous‐variable systems. Here we report on the experimental generation of an important example of a continuous‐variable cluster state, a four‐mode linear cluster state.

The blood supplies of nodular lesions associated with liver cirrhosis were analyzed in vivo with various imaging modalities. The portal blood supply was evaluated with computed tomography (CT) during arterial portography (CTAP); the arterial blood supply was evaluated with hepatic angiography, CT angiography, CT following intraarterial injection of iodized oil, or ultrasound following intraarterial injection of carbon dioxide microbubbles. A total of 84 surgically confirmed hepatocellular carcinomas (HCCs) (less than or equal to 3 cm) and 25 areas of adenomatous hyperplasia (AH) were included in the study. At CTAP, a portal blood supply was seen in 96% of cases of AH and only 6% of HCCs (chi 2, P less than .005). In contrast, an arterial supply greater than that of the surrounding liver was verified in 94% of the HCCs and only 4% of the cases of AH (chi 2, P less than .005). The blood supply of areas of AH with atypical hepatocytes and the blood supply of well-differentiated HCCs (Edmondson grade 1) tended to be intermediate between that of AH without atypia and that of HCC that was Edmondson and Steiner grade 2 or greater. Evaluation of the blood supply of the nodular lesions associated with liver cirrhosis is considered to be useful in the differential diagnosis and treatment of early-stage HCC.

To examine the frequency of the right hepatic arterial supply to the posterior aspect of segment IV (PASIV) of the liver shown on computed tomography (CT) during hepatic arteriography (CTHA).Seventy-four patients who underwent CTHA from the right and/or left hepatic artery were studied. The right arterial supply to the PASIV was determined when the PASIV was stained on CT during right hepatic arteriography without any opacified arteries originating from the right hepatic artery and distributing to segment IV through the left hepatic hilum or when no staining was seen in the PASIV on CT during left hepatic arteriography. The frequency of the right hepatic arterial supply to the PASIV demonstrated on CTHA was analyzed.In six of 74 patients (8%), the PASIV was supplied from the right hepatic artery.This PASIV was supplied by the right hepatic artery in a significant proportion of cases.

To clarify the correlation between aberrant gastric venous drainage and a focal spared area at the posterior edge of segment IV in fatty liver by using color Doppler ultrasound (US).Seventeen patients with fatty liver were examined with gray-scale, color Doppler, and power Doppler US. In one patient with a focal spared area, arteriography and computed tomography (CT) were performed during injection of contrast medium into the right gastric artery.Focal spared areas of fatty liver at segment IV were shown in five of 17 patients. In all five patients with a focal spared area, aberrant gastric venous drainage was observed with color Doppler US. Power Doppler US depicted aberrant gastric venous drainage more clearly than color Doppler US. On the other hand, no definite aberrant gastric venous drainage was seen in the 12 patients who had no focal spared area. In one patient who underwent selective arteriography of the right gastric artery and CT arteriography, aberrant gastric venous drainage into segment IV was directly demonstrated.Focal spared areas at segment IV in fatty liver correlate strongly with aberrant gastric venous drainage. Noninvasive imaging methods such as color and power Doppler US are useful for depicting these aberrant drainage veins.

Angiotensin II plays a significant role in cell growth and proliferation in model systems and in humans. Numerous studies have shown that left ventricular hypertrophy (LVH) increases the risk of coronary heart disease, congestive heart failure, stroke or transient ischemic attack; all-cause deaths, and sudden death. The use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) has provided beneficial effects on LVH regression and on cardiac remodeling in the presence of hypertension and heart failure. The new class of ARBs appears to provide cardioprotective effects that are similar to those of the ACE inhibitors. Most of the beneficial effects provided by these agents appear to be related to a more complete blockade of the angiotensin II type 1 (AT1) receptor. However, costimulation of the angiotensin II type 2 (AT2) receptor appears to increase nitric oxide and thus causes some bradykinin-like effects. Evidence for the role of angiotensin II in promoting LVH as well as abnormal regulation of the angiotensin II signal transduction pathways in model systems and in humans has been reviewed. Secondly, the mechanisms for the beneficial effects of angiotensin II receptor blockers studied in model systems and in humans, including possible involvement in the formation of reactive oxygen species by mononuclear cells, are presented. Finally, results from large-scale interventions such as the Losartan Intervention For Endpoint reduction (LIFE) study, as well as an overview of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial involving the use of ARB in high-risk patients, are presented.

65 nm node SoC technology has been achieved to show good yield of 8 Mbit DRAM ADM using tapered BF/sub 2/ implantation without an additional mask step, the cell size of which is 0.11 /spl mu/m/sup 2/, with 3 layers of hybrid low-k material, SiLK/BD/BLOk, and Cu integration.

Vascular endothelial growth factor (VEGF) is highly expressed in the airway of asthmatic patients. As VEGF increases airway vascular permeability, consequent thickening of the airway wall mucosa may lead to narrowing of the airway lumen.We evaluated the relationship between VEGF levels in induced sputum and eosinophilic inflammatory profiles, and the degree of airway vascular permeability in asthmatic patients and we evaluated the effect of inhaled corticosteroids on VEGF levels in induced sputum.Induced sputum specimens were obtained from 28 glucocorticosteroids free asthmatics and 11 healthy control subjects. We examined VEGF levels and airway vascular permeability index in induced sputum. After the initial sputum induction, 21 asthmatics received 8-week inhaled beclomethasone dipropionate (BDP, 800 micro g/day) therapy, then sputum induction was repeated.The VEGF levels in asthmatics were significantly higher than in healthy control subjects (P0.0001). The VEGF levels were negatively correlated with forced expiratory volume of 1 s (FEV1, % predicted, r = - 0.68, P0.001), the percentage of eosinophils (r = 0.51, P0.01) and ECP levels (r = 0.39, P0.05). Moreover, the VEGF levels were significantly correlated with airway vascular permeability index (r = 0.61, P0.001). After 8-week inhaled BDP therapy, the VEGF levels were significantly decreased compared to pretreatment levels (P0.0001) and the VEGF levels were significantly correlated with airway vascular permeability index even in post-treatment asthmatics (r = 0.62, P0.01).The VEGF levels in induced sputum were increased in asthmatics and its levels were associated with degree of airway narrowing and airway vascular permeability. These findings provide strong evidence that VEGF may play an important role in the pathogenesis of bronchial asthma.

Objective: To explore the application of a new 10 French intracardiac echocardiography (ICE) catheter with phased array and Doppler capable transducer for the assessment of epicardial and intramyocardial coronary blood flow. Methods: The coronary arteries were detected by cross sectional imaging in seven closed chest dogs, and coronary blood flow visualised by colour Doppler. Blood flow velocities were recorded by pulsed Doppler at baseline for reproducibility of repeated measurements, and during hyperaemia for coronary flow reserve measurements. Comparisons were made with Doppler guide wire data obtained simultaneously. Intramyocardial coronary artery blood flow was assessed by colour flow mapping, and the blood flow velocities recorded using pulsed Doppler at baseline and during hyperaemia. Results: Seven left main, six left anterior descending, seven left circumflex, and five right coronary arteries were visualised in the seven animals by cross sectional or colour Doppler imaging. Repeated measurements of coronary flow velocity showed a good correlation (mean diastolic velocity, r = 0.93, n = 22, p < 0.0001; peak diastolic velocity, r = 0.96, n = 22, p < 0.0001, respectively). Intraobserver/interobserver variability was satisfactorily low. Coronary flow reserve from ICE correlated highly with the value obtained from the Doppler guide wire (r = 0.90, n = 26, p < 0.0001). Intramyocardial coronary blood flow was identified in all seven dogs, and flow velocities were recorded at baseline and during hyperaemia in four animals. Conclusions: This new ICE catheter provides high quality diagnostic resolution. It is useful for coronary blood flow assessment.

To assess long-term prognosis of clinically silent, early-stage avascular necrosis of the femoral head (ANFH) in patients with systemic lupus erythematosus (SLE).Twenty-four hips that showed ANFH by magnetic resonance imaging (MRI) in 13 patients with SLE were studied. All hips were radiographically normal and clinically asymptomatic. The percentage volume of necrotic bone was calculated at each study by dividing the sum of the necrotic areas by the sum of the femoral head areas from all MRI slices. Hips were also classified into three categories by the relation of the necrotic area to the weight bearing portion according to the system of the Japanese Investigation Committee for avascular necrosis of the femoral head, with modifications: Type A (medial lesions): 8 hips, Type B (central lesions): 4 hips, and Type C (lateral lesions): 12 hips. Patients were followed up with MRI for 12-95 (mean 51) months.Fifteen hips improved (more than 15% reduction in the volume of necrosis), 5 did not change and 4 worsened during the observation period. All hips with a volume of necrotic area less than 25% showed improvement. All but one Type A hip and one Type B hip improved, while the mean volume of necrosis did not change in Type C. The volume of the necrotic area was smaller in Type AB than in Type C hips (p0.001).Long-term prognosis of early-stage ANFH was favorable in patients with SLE when the necrotic area was small (less than 25%).

Background: The production of peroxynitrite, an extremely potent oxidant, is increased in inflammatory lung disease. It is therefore important to measure antioxidant activity against peroxynitrite in epithelial lining fluid to examine the physiological effects of peroxynitrite in the airways of patients with asthma. This study was designed to determine whether peroxynitrite inhibitory activity in induced sputum is correlated with clinical characteristics and airway inflammatory indices in asthmatic patients. Methods: Inflammatory indices were measured in induced sputum from 25 patients with asthma and 12 normal control subjects. Peroxynitrite inhibitory activity was also measured by monitoring rhodamine formation in sputum samples. Results: Peroxynitrite inhibitory activity in induced sputum was significantly lower in asthmatic patients (52.4 (24.5)%) than in normal control subjects (92.1 (3.9)%, p

The purpose of this study was to examine the effect of diltiazem on cardiac function and neurohumoral factors (BNP, epinephrine, norepinephrine) after reperfused myocardial infarction without congestive heart failure (Killip class I). On the first day after myocardial infarction following reperfusion therapy patients were randomly assigned to diltiazem treatment (group 1, n=33) or no treatment (group 2, n=39). We then performed echocardiographic examinations on the patients and measured heart rate, mean blood pressure and neurohormones (BNP, epinephrine and norepinephrine). Follow-up evaluations of echocardiography were performed at 4 and 12 weeks and of neurohormones at 1 and 4 weeks after acute myocardial infarction. The highest peaks of plasma BNP, epinephrine, and norepinephrine levels were observed before treatment and decreased with time in both groups. After 4 weeks the level of plasma BNP in the diltiazem treatment group was lower than in the no treatment group [55+/-3 pg/mL vs 85+/-5 pg/mL (P0.05)]. Other neurohormones did not differ between groups. Fractional shortening (FS) and ejection fraction (EF)improved after myocardial infarction in both groups, but significantly more in the diltiazem group (P0.05) after 12 weeks of treatment. Changes in BNP correlated significantly with changes in left ventricular end systolic volumes, FS and EF. In this study, diltiazem significantly improved systolic function and reduced the level of plasma BNP after myocardial infarction, which suggest that diltiazem may have a beneficial effect on myocardial infarction without congestive heart failure.

Three-dimensional(3-D) echocardiography accurately calculates left ventricular volumes without geometric assumptions. Conventional 3-D echocardiography using the disk summation method is limited in practical use because of the long analysis time. This study validated the average rotation method for rapid and accurate left ventricular volume measurement compared with the conventional disk summation method.3-D data acquisition using multiplane transesophageal echocardiography was performed in 13 patients. Left ventricular volumes and ejection fraction were calculated by the disk summation method with 20 parallel short-axis tomograms and by the average rotation method with 3, 6, 9 and 12 apical long-axis tomograms.3-D left ventricular volumes and ejection fraction by the average rotation method in each subgroup of slice resolution had excellent correlation and close limits of agreement with those by the disk summation method. Intraobserver variability and interobserver variability wereor = 11%. With the use of three component tomograms, analysis time required for left ventricular volume measurement by the average rotation method wasor = 2 min.Transesophageal 3-D echocardiography using the average rotation method is a clinically useful tool for accurate and rapid measurement of left ventricular volume and function.

We describe a case in which bilateral chylothorax was the initial presenting manifestation of a gastric cancer (scirrhous type). A 58-year-old woman was admitted because of acute right subclavian vein thrombosis. Following admission, she complained of dyspnea on effort and on the 14th hospital day chest X-ray examination revealed bilateral pleural effusion. Biochemical tests of the pleural fluid detected chyle, and cytological examinations revealed mucinous adenocarcinoma bilaterally. An upper gastrointestinal examination revealed gastric cancer (scirrhous type). Carcinoma of the stomach has very rarely been described as the cause of chylothorax, but our findings indicate the need to rule out a gastric neoplasm in patients with chylothorax of no clear cause.

Recent technological advances in transthoracic Doppler echocardiography (TTDE) provide visualization of the coronary blood flow signal and noninvasive analysis of coronary flow reserve with a high frequency transducer. Coronary flow velocity and coronary flow reserve measured by TTDE were compared with those measured by a Doppler guide wire. Values of mean coronary flow velocity and coronary flow reserve measured by TTDE were closely correlated with values measured by the invasive Doppler guide wire (r = 0.97, y = 0.94x + 0.40; r = 0.94, y = 0.95x + 0.21, respectively). This noninvasive technique was applied to patients who underwent coronary angiography to evaluate coronary artery disease. There was a significant difference in coronary flow reserve measured by TTDE between patients with and without significant left anterior descending coronary artery stenosis (% diameter stenosis70%) (1.5 +/- 0.2 vs 2.6 +/- 0.4, p0.001). Coronary flow reserve2.0 obtained by TTDE had a high sensitivity (92%) and a high specificity (86%) for the presence of significant left anterior descending coronary artery stenosis. TTDE with a high-frequency transducer can be applied to noninvasive estimation of coronary flow reserve in the clinical setting, and is useful in noninvasive diagnosis of significant coronary stenosis in patients with coronary artery disease.

The number of elderly patients with lung cancer is rapidly increasing and their management is an important issue.109 patients aged over 75 years with unresectable non-small cell lung cancer were assessed to define the prognostic factors. The median age was 80 years in a range of 76 to 95. The overall median survival time was 6.3 months. Fifty-one patients underwent chemotherapy and/or thoracic radiotherapy whilst the others received best supportive care.Multivariate Cox regression model showed performance status (PS) (p = 0.0063) and stage of disease (p = 0.0158) to be independent prognostic factors for survival. In seventy-six patients with a good PS of 0-1, choice of treatment (p = 0.0225) and hyponatremia (p = 0.0302) were the predictors for survival.PS, treatment and serum sodium level were important factors for survival, and most patients with good PS were able to undergo the treatment and have a good outcome.