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Purpose: We compared quantitative indices estimated by use of technetium-(99m) galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/computed tomography (CT) fused imaging and hepatic fibrosis in patients with chronic liver disease.Materials and Methods: On the basis of pathological findings we divided 161 patients into non-severe and severe fibrosis groups (n = 81 and n = 80, respectively). We measured 2 indices by (99m)Tc-GSA SPECT/CT fused imaging: liver uptake value (LUV) = [radioactivity (whole liver)/radioactivity (injected)] × 100/body surface area, and functional liver index (FLI) = [radioactivity (hepatocytes)/radioactivity (injected)] × 100/liver volume. We compared these indices with biochemical and histopathological results.Results: Univariate and multivariate analyses showed that FLI, LUV, LHL15, and prothrombin time were significant independent predictors of severe fibrosis. On the basis of receiver operating characteristics analysis, the areas under curve values of FLI, LUV, LHL15, and prothrombin time for predicting severe fibrosis were 0.83, 0.73, 0.69, and 0.68, respectively. Using an FLI value of 0.053, it was possible to predict severe fibrosis with 65 % sensitivity, 88 % specificity, and 76 % accuracy.Conclusion: Assessment of functional hepatocytes by use of (99m)Tc-GSA SPECT/CT fused images is useful for identifying pathological liver fibrosis. [ABSTRACT FROM AUTHOR]

Abstract: We investigate the dispersion in the hole Fermi surfaces (FSs) and the superconducting (SC) gaps of BaFe2(As0.65P0.35)2 by employing bulk-sensitive angle-resolved photoemission spectroscopy (ARPES) with low energy photons. We find that this material exhibits a comparable magnitude of SC gaps for three-hole FSs at . The comparable magnitude of the SC gap is observed also at 0. Since each FS sheet has a distinct orbital character, these observations are an indication of the orbital-independent SC gaps in the hole FSs. [Copyright &y& Elsevier]

Abstract: We examined the ultrafast response of the metallic high-temperature phase in the conducting charge transfer complex (EDO-TTF)2PF6. A large reflectivity change of approximately 10% was observed when the intra-molecular band was excited by a weak 3.1eV ultraviolet light pulse. The lifetimes of the photo-induced states were 0.2 and 0.7ps in the Drude-like band and the intra-molecular band, respectively. Measurement of the photo-induced spectrum just after photo-excitation and simulation using the Drude model revealed that the electronically excited EDO-TTF molecules shortened the relaxation time of conduction electrons and reduced the reflectivity of the Drude-like band. [Copyright &y& Elsevier]

Objective: To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations., Materials and Methods: We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations., Results: University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape., Discussion: Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation., Conclusion: EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Diphenylarsinic acid (DPAA) was a major compound found in the arsenic poisoning incident that occurred in Kamisu, Ibaraki, Japan in 2003. People exposed to DPAA via contaminated well water suffered from several neurological disorders, including cerebellar symptoms. We previously reported that DPAA induces cellular activation in cultured rat cerebellar astrocytes, dose-dependent promotion of cell growth (low DPAA), cell death (high DPAA), and increased phosphorylation of mitogen-activated protein (MAP) kinases (p38MAPK, SAPK/JNK, and ERK1/2). Moreover, DPAA induces up-regulation of oxidative stress-counteracting proteins, activation of CREB phosphorylation, increased protein expression of c-Jun and c-Fos, and aberrant secretion of brain-active cytokines (MCP-1, adrenomedullin, FGF2, CXCL1, and IL-6). Here, we explored the role of MAP kinases in DPAA-induced activation of astrocytes using specific MAP kinase signaling inhibitors [SB203580 (p38MAPK), SP600125 (SAPK/JNK), SCH772984 (ERK1/2), and U0126 (MEK1/2, a kinase for ERK1/2)]. DPAA-induced activation of MAP kinases had little contribution to DPAA-induced cell growth and death. On the other hand, a power relationship among MAP kinases was also observed, in which p38MAPK suppressed DPAA-induced SAPK/JNK and ERK1/2 activation, whereas ERK1/2 and MEK1/2 facilitated p38MAPK and SAPK/JNK activation. In addition, SAPK/JNK had minimal effects on the activation of other MAP kinases. DPAA-induced activation of transcription factors and secretion of brain-active cytokines were submissively but intricately dominated by MAP kinases. Collectively, our results indicate that DPAA-induced activation of MAP kinases is neither a cell growth-promoting response nor a cytoprotective one but leads to transcriptional disruption and aberrant secretion of brain-active cytokines in cerebellar astrocytes., (© The Author 2017. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Diphenylarsinic acid (DPAA) was detected as the primary compound responsible for the arsenic poisoning that occurred in Kamisu, Ibaraki, Japan, where people using water from a well that was contaminated with a high level of arsenic developed neurological (mostly cerebellar) symptoms and dysregulation of regional cerebral blood flow. To understand the underlying molecular mechanism of DPAA-induced cerebellar symptoms, we focused on astrocytes, which have a brain-protective function. Incubation with 10 µM DPAA for 96 h promoted cell proliferation, increased the expression of antioxidative stress proteins (heme oxygenase-1 and heat shock protein 70), and induced the release of cytokines (MCP-1, adrenomedullin, FGF2, CXCL1, and IL-6). Furthermore, DPAA overpoweringly increased the phosphorylation of three major mitogen-activated protein kinases (MAPKs) (ERK1/2, p38MAPK, and SAPK/JNK), which indicated MAPK activation, and subsequently induced expression and/or phosphorylation of transcription factors (Nrf2, CREB, c-Jun, and c-Fos) in cultured rat cerebellar astrocytes. Structure-activity relationship analyses of DPAA and other related pentavalent organic arsenicals revealed that DPAA at 10 µM activated astrocytes most effective among organic arsenicals tested at the same dose. These results suggest that in a cerebellum exposed to DPAA, abnormal activation of the MAPK-transcription factor pathway and irregular secretion of these neuroactive, glioactive, and/or vasoactive cytokines in astrocytes can be the direct/indirect cause of functional abnormalities in surrounding neurons, glial cells, and vascular cells: This in turn might lead to the onset of cerebellar symptoms and disruption of cerebral blood flow., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Background: Chronic diseases affect 52% of Americans and consume 86% of health care costs. A small portion of patients consume most health care resources and costs. More intensive patient management strategies, such as case management, are usually more effective at improving health outcomes, but are also more expensive. To use limited resources efficiently, risk stratification is commonly used in managing patients with chronic diseases, such as asthma, chronic obstructive pulmonary disease, diabetes, and heart disease. Patients are stratified based on predicted risk with patients at higher risk given more intensive care. The current risk-stratified patient management approach has 3 limitations resulting in many patients not receiving the most appropriate care, unnecessarily increased costs, and suboptimal health outcomes. First, using predictive models for health outcomes and costs is currently the best method for forecasting individual patient's risk. Yet, accuracy of predictive models remains poor causing many patients to be misstratified. If an existing model were used to identify candidate patients for case management, enrollment would miss more than half of those who would benefit most, but include others unlikely to benefit, wasting limited resources. Existing models have been developed under the assumption that patient characteristics primarily influence outcomes and costs, leaving physician characteristics out of the models. In reality, both characteristics have an impact. Second, existing models usually give neither an explanation why a particular patient is predicted to be at high risk nor suggestions on interventions tailored to the patient's specific case. As a result, many high-risk patients miss some suitable interventions. Third, thresholds for risk strata are suboptimal and determined heuristically with no quality guarantee., Objective: The purpose of this study is to improve risk-stratified patient management so that more patients will receive the most appropriate care., Methods: This study will (1) combine patient, physician profile, and environmental variable features to improve prediction accuracy of individual patient health outcomes and costs; (2) develop the first algorithm to explain prediction results and suggest tailored interventions; (3) develop the first algorithm to compute optimal thresholds for risk strata; and (4) conduct simulations to estimate outcomes of risk-stratified patient management for various configurations. The proposed techniques will be demonstrated on a test case of asthma patients., Results: We are currently in the process of extracting clinical and administrative data from an integrated health care system's enterprise data warehouse. We plan to complete this study in approximately 5 years., Conclusions: Methods developed in this study will help transform risk-stratified patient management for better clinical outcomes, higher patient satisfaction and quality of life, reduced health care use, and lower costs.

Background: The effects of electronic health records (EHRs) on doctor-patient communication are unclear., Objective: To evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills., Design: Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication., Setting: A large academic internal medicine training program., Population: First-year internal medicine residents., Intervention: Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale., Results: Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR., Limitations: This study was conducted in first-year residents in a training environment using simulated patients at a single institution., Conclusions: Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart., (© The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Purpose: To evaluate the role of hepatic asialoglycoprotein receptor analysis in the preoperative estimation of postoperative hepatic functional reserve., Methods: We obtained technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-GSA) SPECT/CT fusion images in 256 patients with liver disease scheduled for hepatic resection. The liver uptake value corrected for body surface area [LUV(BSA)] and liver uptake ratio (LUR) of the remnant were preoperatively estimated based on the fused images. These values were compared with the postoperative hepatic functional reserve., Results: Significant correlations were observed between LUV(BSA), LUR, and most conventional indicators of hepatic functional reserve. Postoperatively, nonpreserved liver functional reserve was observed in 15 of the 256 patients (5.8%). Remnant LUV(BSA) showed better correlation than remnant LUR or the other indicators. No patients with remnant LUV(BSA) above 28.0 manifested poor nonpreserved functional reserve. Using a LUV(BSA) of 27.0, it was possible to predict postoperative poor hepatic functional reserve at a sensitivity of 91%, specificity of 81%, and accuracy of 81% postoperatively. According to multivariate analysis, a low remnant LUV(BSA) was the only significant independent predictor of poor hepatic functional reserve., Conclusions: Our 99mTc-GSA SPECT/CT fusion imaging method was clinically useful for evaluating regional hepatic function and for predicting postoperative hepatic functional reserve.

Objective: Imperfect image resolution because of finite-sized collimator channels often causes a decrease in diagnostic performance in myocardial perfusion single-photon emission computed tomography (SPECT). This prompted us to evaluate the clinical usefulness of collimator distance dependent resolution recovery (RR) in myocardial perfusion SPECT., Methods: We retrospectively reviewed myocardial SPECT images of 60 consecutive patients (26 men, 34 women; mean age 68 years). They consisted of 25 with coronary artery disease (CAD) and 35 without, as confirmed by the coronary angiography (CAG). The patients had undergone myocardial perfusion SPECT imaging with thallium-201 (111 MBq) under an exercise or pharmacological stress protocol. Two readers reviewed the myocardial SPECT images for the presence of CAD on a 4-point scale where 0 = normal, 1 = probably normal, 2 = probably abnormal, and 3 = abnormal. Three reading sessions were held: first, ordered subsets expectation maximization (OSEM) SPECT images, second, OSEM with RR images, and third, both OSEM and RR images. Diagnostic performance for accuracy of coronary arterial stenoses was compared for OSEM, RR and both the images., Results: The sensitivity increased using RR images, but specificity decreased, and thus overall diagnostic accuracy was decreased, as compared with using OSEM images. The overall accuracy of using both the images showed the highest diagnostic performance among the three sets of image interpretations. The sensitivity, specificity and accuracy were 33, 92, 77% for OSEM, 53, 79, 72% for RR and 51, 90, 80% for both the images., Conclusions: These results suggest that RR for myocardial perfusion SPECT imaging has some potential to improve diagnostic accuracy, but both OSEM and RR image sets may have to be employed for the best diagnosis of CAD.

Two-photon confocal microscopy is a new technology useful in nondestructive analysis of tissue. The pattern generated from laser-excited autofluorescence and second harmonic signals can be analyzed to construct a three-dimensional, microanatomical, structural image. The healing of full-thickness guinea pig skin wounds was studied over a period of 28 days using two-photon confocal microscopy. Three-dimensional data were rendered from two-dimensional images and compared with conventional, en face, histologic sections. Two-photon confocal microscopy images show resolution of muscle, fascia fibers, collagen fibers, inflammatory cells, blood vessels, and hair. Although these images do not currently have the resolution of standard histology, the ability to noninvasively acquire three-dimensional images of skin promises to be an important tool in wound-healing studies.

In order to elucidate upon the interrelationships among the different structures in and around the nasal cavity, the noses of 95 adults without severe rhinitis, paranasal sinusitis, cysts or tumors were examined by means of X-ray tomography. The results indicate a close correlation between the width of the nasal cavity and 1) the width of the maxillary sinus, 2) the size, form and height of the inferior turbinate, 3) the size of the middle turbinate or 4) the nasal septal deviation; between the height of the nasal cavity and the length and height of the inferior turbinate or the length of the middle turbinate, and also between the degree of septal deviation and the width of the nasal cavity, the nasal meatus or olfactory slit or the form of the inferior turbinate. In conclusion, it is recognized that correction of the abnormal interrelationships among the different structures is important for functional nasal surgery.

Laser therapy for bile duct stones, such as the non-contact beam treatment using continuous wave of Nd:YAG laser or contact beam treatment using ceramics rod, has been done in our institution from 1980. As a result, the ratio of complete lithotomy has been increased from 31/47 (66%) to 66/71 (93%). Recently, we had a opportunity to use the Lasertripter by Candera Corp., which was devised for urinary stones. It beams pulse wave to crush stones. The effectiveness of this new laser lithotripsy is different according to the kind of the stones, but it is better than that of conventional YAG laser. Furthermore, as this method can be used with thin fiberscope, this method is more effective to peripheral intrahepatic stones than YAG laser.