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Background Implantation of implantable cardioverter-defibrillators (ICD) for secondary prevention is fully recommended for those with an estimated survival over 1-year with a good functional status. However, we often face the difficulty to estimate the functional status and hesitate to implant ICD for patients with post-resuscitation encephalopathy. Methods There were 2391 out-of-hospital cardiac arrest (OHCA) patients transferred to 2 hospitals. We included 405 cardiovascular arrest patients, who got return of spontaneous circulation (ROSC) from January 2015 to December 2018. Among the patients, 343 patients could be considered to be implanted ICD for secondary prevention according to the initial waveform or the causes of OHCA. At 1-month later, 184 patients (54%) survived. To assess the association of functional status at 30-day and 1-year, we investigated patients' characteristics, pre-hospital information and clinical findings, and evaluated the neurological outcome according to the cerebral performance category (CPC) scale. Results At 1-month later, 145 patients (79%) survived with CPC≤2, and 39 patients (21%) survived with CPC>2. Bystander CPR (P=0.009), pre-hospital ROSC (P2 at 30-day:38.5%, vs CPC≤2 at 30-day:97.2%; P2 at 30-day, only 3 patients (7.7%) of CPC=3 achieved the improvement of neurological outcome at 1-year (CPC≤2), while no patient of CPC=4 did. And one patient (2.5%) with CPC=3 was implanted ICD during the follow-up period. Twenty-five patients (64%) died of non-cardiovascular death with frailty of post-resuscitation encephalopathy after they were transferred to other hospital with the acceptation and intention of the do-not-attempt-resuscitation. Conclusions Neurological prognosis at 30-day after OHCA might be an estimator of 1-year functional status to guide us to implant ICD for secondary prevention. Funding Acknowledgement Type of funding sources: None.

Background The long-term prognosis of survival in patients with out-of-hospital cardiac arrest (OHCA) with coronary artery disease (CAD) remains poor. Methods There were 2391 out-of-hospital cardiac arrest (OHCA) patients transferred to 2 hospitals. We included 405 cardiovascular arrest patients, who got return of spontaneous circulation (ROSC) from January 2015 to December 2018. Among them, 204 patients had CAD that caused OHCA (39%: multi-vessel disease, 19%: chronic total occlusion (CTO), 13%: vasospastic angina (VSA)). To predict mortality, we investigated patients' characteristics, pre-hospital information and findings of CAG. Results At 1-year later, 104 patients (51%) survived. Younger age (P Conclusions Younger age and pre-hospital support after OHCA with CAD were the predictors of low mortality. Pre-hospital information, systemic condition on arrival, or anatomical coronary complexity were important to predict low mortality. Funding Acknowledgement Type of funding sources: None.

Background Fluoine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is a useful modality of inflammatory disease. Epicardial adipose tissue (EAT) contains abundant ganglionated plexi, therefore EAT inflammation may cause atrial arrhythmia, such as atrial premature contraction (APC) and atrial fibrillation (AF). Previous studies have shown that inflammatory activity of EAT has relation to the presence of AF. However, it is unknown whether EAT inflammation contributes to the occurrence of AF. Methods Out of 20720 examinees who underwent FDG-PET/CT for screening of cancer in the years 2012–2018, 151 (aged 65.6±12.0 years old, 62 females) had ambulatory electrocardiographic monitoring (Holter ECG) within a year and non-detection of AF. Standardized uptake value (SUV) was measured in fat adjacent to roof of left atrium (ROOF), atrioventricular groove (AV), left main coronary artery (LMT), and right ventricular blood pool (RV). In order to correct for blood pool activity, SUV of ROOF, AV, and LMT were divided by SUV of RV respectively, yielding target-to-background ratio (TBR). As regards to arterial inflammation, measurements were performed with SUV in ascending aorta (A-Ao) and in superior vena cava (SVC) as blood pool. In the same way, SUV of A-Ao was divided by SUV of SVC, yielding TBR. Results According to Holter ECG, APC≥100 beats per day was seen in 60 patients (Group A), but not in the other 91 (Group B). In Group A, TBR of ROOF, AV, and LMT were all significantly higher than Group B (p Conclusions Although EAT inflammation evaluated by SUV is related to frequent APCs, only in fat adjacent to roof of left atrium is associated with and predicts future occurrence of AF. Arterial inflammation measured by SUV has no relation to atrial arrhythmia.

It was shown in our previous reports that a few spores of moss Venturiella could tolerate the very high pressure of 20 GPa for 30 min and germinated a protonema to the length of 30 μm. However, these spores did not grow any further, and disappeared at around 30 days of incubation after seeded. On the other hand, colonies of blue-green alga Microcystis flos-aquae came to appear about 76 days after the moss spores were seeded. Many of these colonies appeared at the places where the moss spores had disappeared. These colonies were formed by the algae that had adhered to the spore cases of the moss and survived after exposure to the very high pressure of 20 GPa. Though the appearance of the colonies of high pressure exposed algae was delayed by about 50 days compared with that of the control group which was not exposed to high pressure, there seems no difference in their shape and color from those of the control group. The pressure tolerance of blue-green alga is found to be enormously strong, and it can survive after exposure to the high pressure which corresponds to the depth of about 550–600 km from the surface of the Earth, just above the lower mantle.

In our previous studies on the tolerance of living organisms such as planktons and spores of mosses to the high hydrostatic pressure of 7.5 GPa, we showed that all the samples could be borne at this high pressure. These studies have been extended to the extreme high pressure of 20 GPa by using a Kawai-type octahedral anvil press. It was found that the average diameter of the spores of Venturiella exposed to 20 GPa for 30 min was 25.5 μm, which is 16.5% smaller (40.0% smaller in volume) than that of the control group which was not exposed to high pressure. The inner organisms showed a further extent of plastic deformation. As a result, a gap appeared between the outer cover and the cytoplasm. A relationship has been obtained between the survival ratio and plastic deformation of spores of moss Venturiella caused by the application of ultra high pressure.

From 1926 to 1969, a long term solar full disk observation was done by Kyoto University. Daily, Ca II K (393.4 nm) spectroheliographic images and white light images were recorded on photographic plates. In this report, we will give the current status of our project to digitize all these images and to construct a database of these images for public use through the IUGONET system. In addition, we will discuss our perspective on the scientific analysis of the database by taking the solar CaII K brightness as a proxy measure of the solar UV irradiance on the terrestrial upper atmosphere.

This paper proposes using CORBA as communication architecture to integrate network-distributed software and robotic systems in support systems for the aged or disabled. The proposed method keeps system costs low and expands availability. Its high scaling and inter-operating ability allows clients and server objects that are written in different languages, run in different operating systems, and connected to different networks to inter-operate. It also enables the system to be extended and integrated with other technologies and applications distributed over the Internet. Based on CORBA, we developed hardware base including a robot arm and an omnidirectional mobile robot and application servers including a task-level robot arm control server, live feedback image server, mobile robot control server and iGPS server. By remotely controlling mobile robot to cooperate with the robot arm, the caregivers or family member can use the developed system for some basic services to the aged or disabled.

Ion irradiation often causes amorphization in a crystal. We have presented a new crystallographic analysis that defines a new type of order parameter, which we call pixel mapping (PM). PM can describe algebraically to what extent and how the crystallinity has changed under ion bombardment. In other words, PM describes the long-range-order (LRO) interactions, based on the crystallography. PM can be effectively used, when it is incorporated in a classical molecular dynamics (MD) calculation. In the case of B ions implanted into a Si crystal, we observed crystal to amorphous (CA) transitions under energetic ion bombardment at low temperature. The PM profiling was more effective to reveal the CA transition than other atomistic methods of analyses as radial distribution function g(r) or vacancy mapping Nv. PM could distinguish between perfect crystalline states, transition states, and random states. Moreover, PM revealed that the lattice reaction was cooperative even in a mesoscopic volume, e.g. in a cube of 60 A × 60 A × 60 A, indicating the importance of LRO interactions.

We have studied the lateral range straggling, ΔR L, for ions implanted into a crystal, and formulated the velocity dependence of the ratio of the lateral to longitudinal range straggling, ΔR L/ΔR p. The targets had diamond structure, e.g., C(diamond), Ge, and Si, all of which had (100) and (110) surfaces. The projectiles were chosen so that the mass-ratio (μ = m 2/m 1) spans from 0.1 to 10. They were implanted into a random direction because of the application viewpoint. The region of the ion velocity, ν, corresponded to the so-called intermediate energy region, where the electronic stopping power, S e, increased from the minimum to the maximum value. We obtained a power function of ν for ΔR LΔR p, whose two parameters are also power function of μ. The result comprehended the LSS results given for amorphous Si. In order to clarify the crystalline effect on ΔR L/ΔR p, we expanded the frame of calculation. Here the impinging ions were faced on (100) and (110) directions of those crystals. The resul...

297 Vitamin D like activity of peony flower extract and effect on skin barrier function H Furumura, M Ogura, H Iwano, Y Hada and S Sawaki Technoble Co., Ltd., Osaka, Japan In 2012, the International Osteoporosis Foundation has reported that one of three subjects is lack of vitamin D in developing and developed countries and it is a serious problem in the world. The problem is caused by modern lifestyle which people try to avoid UV rays, because vitamin D is made by UV rays in skin. It has been reported that vitamin D is related to bone formation for a long time and nowadays it is getting clear that vitamin D is also related to skin barrier function, therefore it has a possibility that chronic dry and rough skin is caused by lack of vitamin D. In this study, we measured blood vitamin D levels of the subjects and divided them into lack and sufficiency of vitamin D groups with the standard value of 20ng/mL, then prepared dry and rough skin in each group by closed patch of sodium dodecyl sulfate solution. As a result, we found that especially lack of vitamin D group (n1⁄43) tended to be easier to prepare dry and rough skin and more difficult to recover than sufficiency of vitamin D group (n1⁄43). Next, we screened for natural component which has vitamin D like activity binding to vitamin D receptor and activating vitamin D receptor transcriptional activity by reporter assay and finally discovered that peony flower extract has vitamin D like activity with about 5-fold (p

We studied the tolerance of living organisms, such as a small animal (Milnesium tardigradum), a small crustacean (Artemia), non-vascular plants or moss (Ptichomitrium and Venturiella), and a vascular plant (Trifolium) to the extremely high hydrostatic pressure of 7.5 GPa. It turned out that most of the high pressure exposed seeds of white clover were alive. Those exposed to 7.5 GPa for up to 1 day and seeded on agar germinated roots. Those exposed for up to 1 hour and seeded on soil germinated stems and leaves. Considering the fact that proteins begins to unfold around 0.3 GPa, it seems difficult to understand that all the living samples which have been investigated can survive after exposure to 7.5 GPa.

For the purpose of reducing disaster damage by applying information sharing technologies, the research on disaster reduction using crisis-adaptive information sharing technologies commenced in July 2004, as a three-year joint project. In this project, the disaster mitigating information sharing platform, which is effective for disaster mitigation activities, especially for local governments, is developed. This paper describes the results of the three-year project, focusing on the framework of the platform and its application to a local government.

To deploy a search robot rescue system in a disaster struck area, we have been researching and developing an integrated wired and wireless hybrid network for stably transmitting the real-time control and measurement data including video signals from a grouped high-speed search robots in a closed space. In this paper, we propose a hybrid network model for search robot rescue system operating in a basic closed space. We create two scenarios based on search robots' movement. A simulation using a network simulator is performed to evaluate the performances of the hybrid network model in these scenarios.

Recently, mobile devices have functions that allow them to be used as tools for obtaining information from cell-phone Websites. To support universities in Japan by providing communication between those universities and their students in classes or anywhere on campus, the National Institute of Multimedia Education, Japan has developed an online mobile phone campus information system called K-tai Campus. This development was conducted under our policy of providing system functions as an application service provider and that of providing open source systems. In this paper, we describe the design and functions of K-tai Campus, how they provide ease of operation, and we discuss the proper means of connecting both PCs and PC-Websites. This paper also focuses on the communication functions provided for teachers and students to further support education.

This paper proposes a practicable navigation method for multiple mobile robots in a dynamic environment. In the past, many navigation methods have been developed. However, these methods were often limited to single robot, or robots with special mobility such as holonomic ones. From the viewpoint of practical applications, it is indispensable that the number of robots, shape and mobility of robots are arbitrary. In this study a deadlock-free navigation for non-holonomic mobile robots in a dynamic environment is given. In the proposed scheme, the information of the environment and robots are fed back to the system in real-time, and global path planning is cyclically executed. The proposed system can be applied to dynamic environment and a reliable deadlockfree navigation of multiple robots. The real-time on-line path planning is performed by an efficient A* search in configuration spaces representing the robots and environment. The proposed method is tested by some kind of simulations for typical complicated navigation situations. As a result, the effectiveness of the proposed method is verified.

Delivery is an essential task for a mobile robot. Automatically guided vehicles play a crucial role in many factories by performing delivery tasks. The next step involves having mobile robots work in populated environments, such as offices, hospitals, and health care facilities. This paper proposes a service robot that can deliver parcels, letters or documents in such an environment. The design policy, architecture, methodology and implementation of this system are presented.

The population-aging problem is increasingly pressing the society. Thus, developing supporting system to improve care cost and the QoL of these elderly people is becoming particularly and timely important. Because of the dispersal of the elderly and disabled, a standard software architecture that can implement network distributed software sharing and improve the cost of writing and maintaining software is highly demanded. This paper proposes using distributed computing technology CORBA to integrate network distributed software and robotic systems to implement support system for the aged or disabled. Using CORBA as a communication architecture, we developed hardware base, user management server, task-level robot arm control server, live image feedback server, mobile robot control server and iGPS server, which can provide some basic care services to aid the aged and disabled. The developed system has the potential to improve the QoL of the aged or disabled and care cost in the future population-aging society.

This paper presents the development of a mobile robot platform on which various kind of applications can be installed. We aim at an object-level platform that can behave autonomously after a goal is given. In order to realize it, the classical SMPA model (sense-model-plan-action framework) is reviewed and restructured from the viewpoint of realtime control. Intelligent information infrastructure composed of distributed TV cameras, network, computing servers and etc., is configured as an external system to implement realtime environment recognition, global planning and navigation. By utilizing the infrastructure, robot bodies become very simple and inexpensive. On the developed platform, a delivery system is built, and the reliability, usability and versatility of the proposed approach are verified experimentally.

This paper introduces a redundant localization system, combining a low-cost Gaussian pose tracker and a particle filter localiser which is more CPU intensive. Ideally, the Gaussian pose tracker can be used most of the time and the particle filter localiser switched on only when the Gaussian pose tracker fails. The problem studied here is to determine when the Gaussian pose tracker has failed. A number of different measures are proposed which indicate the state of the pose tracker. Experimental results are presented which illustrate the relative performance of the proposed measures. The results demonstrate that a measure derived from the size of the covariance of the Gaussian pose tracker gives a good prediction of when the pose tracker has failed.

This paper describes the concept of telecare robotic system for support of elderly and disabled people using CORBA as communication architecture. The paper also details the architecture and key technologies of implementation of the system. The proposed system gives the care receivers the ability to operate the robotic systems to supply some basic daily services. Human care-givers in management center can manage the control user and control rights of robots, do supervisory control to support the local user, and monitor the state of robot working and the aged or disabled staying alone at home or small-scale distributed facilities by video feedback. Using CORBA as a communication architecture, we developed hardware base, user management server, task-level robot arm control server, live image feedback server, mobile robot control server and iGPS server, which can provide some basic care services to aid the aged and disabled. The developed system has the potential to improve the QoL of the aged or disabled and care cost in the future population-aging society.

This paper proposes a novel method to integrate Internet distributed robotic systems using Common Object Request Broker Architecture for implementing telecare robotic system to aid the aged or disabled. The proposed method makes system have low cost and wide availability, high scaling and inter-operating ability to allow the clients and server objects, written in different languages, run in different operating system, and connected in different network to inter-operate. It also makes it easier for system to be extended and integrated with the other technologies and applications distributed over the Internet. Using CORBA as a communication architecture, we developed hardware base, Web user management server, task-level robot arm control server, live image feedback server, mobile robot control server and iGPS server, which can provide some basic care services to aid the aged and disabled.

In order for a robot to follow a predetermined trajectory accurately, its position must be estimated accurately and reliably. This paper proposes a trajectory tracking control method for a nonholonomic mobile robot that utilizes both iGPS and odometry localization information to precisely calculate the robot's position. The iGPS is an indoor global positioning system that utilizes TV cameras mounted on the ceiling to locate the robot with respect to the world coordinate system. The iGPS localization information is sent to the robot via a wireless LAN, and the robot estimates its position from this information and the robot's internal odometry. The experimental results show that the proposed method enables robust trajectory tracking, even after experiencing a significant disturbance.

Tracking a target robustly by vision is very difficult for a mobile robot running on irregular terrain in a natural environment, because the image deformation caused by rolling and pitching of the camera, as well as relative movement between the target and the camera, affect the tracking ability. One approach to cope with such problems is matching the target image with many affine transformed candidate images while tracking. But when the number of candidate images gets larger, such approach becomes unfeasible because of computational cost. In this paper, we propose Robustness Analysis for Tracking (RAT) to improve the tracking ability. RAT is an analysis based on features of the object image, where three parameters - 'Detectability', 'Robustness for Depth (RBD)' and 'Robustness for Rotation (RBR)' - are defined. Much more robust templates can be found by analyzing the object image using RAT before the tracking task is performed. Experimental results verify the effectiveness of this method.

A delivery service system employing multiple mobile robots, which enables many users to use the delivery service simultaneously, needs the capability to reliably direct robots to their destinations in an office-like environment. In the preliminary stages of our work, we achieved deadlock-free navigation of such a multi-robot system in a static environment, where obstacles did not move. The next stage, which is presented in this paper, progressed to the robust navigation of a multirobot system in a dynamic environment, where obstacles, such as chairs or people, are moving. To do this, we used two methods. The first method recognizes obstacles by a mark-based vision technique and updates the environmental map with iGPS. The second method is a conventional one that detects unknown obstacles by an onboard laser range finder. To test our navigation methods, we conducted actual multi-robot experiments in an office-like environment.

Introduces a methodology that will allow robots to execute tasks autonomously and with a high degree of success. Taking as an example the mobility of a robot without collision in a dynamic environment, a task-level feedback control system is proposed. The key idea is to incorporate the real-time recognition and motion planning functions into the task control loop. For real-time recognition of the environment, mark-based vision is used. In addition, algorithm to do a global motion planning in the environment where movable obstacles exist is proposed. By integrating the real-time recognition and motion planning, we succeed in forming a control loop, for a robust and deadlock free navigation.

We examined the lateral distribution of stopped ions in a crystalline target, considering the correlation between range straggling and the energy loss. Here we focused on the intermediate energy regime. The key quantity is the ratio of the lateral (/spl Delta/R/sub L/) to the longitudinal (/spl Delta/R/sub p/) range straggling in a crystalline target. Making use of a model of the impact-parameter dependent electronic stopping power, S/sub e/, we calculated /spl Delta/R/sub L///spl Delta/R/sub p/ of 10 keV-1 MeV B ions and 20 keV-10 MeV As ions implanted into Si[100] target. The value /spl Delta/R/sub L///spl Delta/R/sub p/ of random ions increased with ion velocity, and this agrees with previous results given for an amorphous target. The velocity dependence of /spl Delta/R/sub L///spl Delta/R/sub p/ closely correlated with that of entire electronic energy loss. On the other hand, in the case of aligned incidence, the /spl Delta/R/sub L///spl Delta/R/sub p/ looked almost invariant even at a high energy when ions receive the maximum S/sub e/. This difference was explained by means of different depth profiles of the energy transfer.

We propose a practical method of multiple mobile robot navigation aimed at the realization of service robots that deliver letters, parcels and documents in an office building. For robust execution of delivery tasks by mobile robots, navigation is important, and localization of robots is a key function for designing robust navigation. We developed a global positioning system for indoor mobile robots by using cameras distributed in the robots' working domain. This system can execute fast and accurate localization of mobile robots. By integrating the positioning system with a deadlock free navigation algorithm for multiple mobile robots, we implemented a successful autonomous service robot system.

Our studies on the tolerance of plants and animals against very high pressure of several GPa have been extended to a smaller sized fungus, the budding yeast Saccharomyces cerevisiae. Several pieces of budding yeast (dry yeast) were sealed in a small teflon capsule with a liquid pressure medium fluorinate, and exposed to 7.5 GPa by using a cubic anvil press. The pressure was kept constant for various duration of time from 2 to 24 h. After the pressure was released, the specimens were brought out from the teflon capsule, and they were cultivated on a potato dextrose agar. It was found that the budding yeast exposed to 7.5 GPa for up to 6 h showed multiplication. However, those exposed to 7.5 GPa for longer than 12 h were found dead. The high pressure tolerance of budding yeast is a little weaker than that of tardigrades.

To evaluate the hypothesis that the expression of the calcium-binding protein parvalbumin (PV) in a subpopulation of gamma-aminobutyric acid (GABA)ergic neurons is an appropriate molecular marker for the effect on ocular dominance plasticity of monocular deprivation during the postnatal sensitive period.Long-Evans rats underwent monocular enucleation immediately before eye opening (postnatal day [P] 14). Immunohistochemical analysis using anti-PV antibody was performed on the superior colliculus (SC) and lateral geniculate nucleus (LGN) at P45. In the visual cortex (VC) developmental changes in immunoreactivity were also examined at the ages of P17, P20, P27, and P45. Northern blot analysis for PV mRNA was also performed at P45. Changes in PV expression in the visual system of these rats were evaluated by use of a computer-based quantitative technique.PV-immunoreactive neurons were present in the SC and VC, whereas only a few were found in the LGN. The monocular enucleation at the onset of the sensitive period markedly reduced PV immunoreactivity in the neuropil of the SC, contralateral to the enucleated eye when examined one month later. No consistent and significant change in PV immunoreactivity was found in either the LGN or the VC. The number of PV-immunoreactive neurons in the VC rapidly decreased to the adult level during the middle of the sensitive period. The expression of PV mRNA in these central visual structures was not affected by early monocular enucleation.Expression of PV is developmentally regulated, and marked changes in its protein expression in the SC can be induced by monocular enucleation. Contrary to the original hypothesis, monocular enucleation did not consistently affect the expression of PV in the rat VC. The expression of PV is probably regulated by multiple factors, not merely by binocular competition.

We undertook a retrospective study of elderly patients with stage III non-small cell lung cancer who had been treated solely with radiotherapy during the period 1986 to 1995. Our study was designed to assess the influence of age on survival and malnutrition in patients aged 75 years or older (elderly group) and patients aged 74 years or younger (younger group). Radiotherapy alone resulted in a median survival period of 11.5 months in the younger group and 6.3 months in the elderly group (p = 0.0043). With the Cox multivariate model, good performance status, age less than 75 years, and good response were significant favorable independent predictors. Furthermore, the elderly group patients more frequently died of respiratory infections and had lower prognostic nutritional indexes than the younger group patients before and after radiotherapy. These findings suggested elderly patients with stage III non-small cell lung cancer who had been treated with radiotherapy alone had a poor prognosis and that malnutrition caused by radiotherapy was a factor contributing to the risk of death from respiratory infection in such patients.

Apical pulsed Doppler tissue imaging can be used to assess the function of regional myocardium. We hypothesized that septal dysfunction might be clarified in the hypertrophic cardiomyopathy (asymmetric septal hypertrophy) by this method. Twenty-one patients with asymmetric septal hypertrophy (mean age 54.8 +/- 11 years) and age-matched 24 normal subjects (52.4 +/- 8 years) were studied. The E/A ratio measured by mitral inflow Doppler was not different between the groups (1.1 vs 1.2). E wave velocities of the septum were significantly decreased in the hypertrophy group compared to the control group (4.0 +/- 1.5 vs 8.1 +/- 2.2 cm/sec), and A wave velocities were increased in the hypertrophic septum, resulting in a significantly lower E/A ratio (0.5 +/- 0.3) compared to the E/A ratio (0.9 +/- 0.3) of the normal septum. Deceleration time of the E wave and isovolumic relaxation time were significantly prolonged in the thick septum compared to the normal septum (136 +/- 51 vs 107 +/- 28 msec, 91 +/- 36 vs 63 +/- 19 msec, respectively). In conclusion, asymmetric septal hypertrophy was characterized by diastolic dysfunction of the thickened septum. Intramyocardial pulsed Doppler echocardiography can detect regional myocardial dysfunction earlier than the mitral inflow Doppler method.

A 66-year-old man presented with Ebstein's anomaly associated with left ventricular dysfunction. He had been followed since 40 years of age for cardiomegaly and arrhythmia, and experienced episodes of orthopnea at the age of 64. He was referred to our hospital in April 1997 because of lower extremity edema. Physical examination revealed dilated external jugular vein, tenderness of the right hypocondorium, and lower extremity edema. Electrocardiography confirmed atrial fibrillation. Transthoracic echocardiography revealed bilateral atrial and ventricular dilation, and paradoxical septal movement. The apical four-chamber view demonstrated 15 mm apical displacement of the septal leaflet. Color Doppler echocardiography revealed moderate tricuspid regurgitation. Transesophageal echocardiography revealed low echoic and hypoplastic tricuspid valve. Left ventriculography showed diffuse hypokinesis, and the ejection fraction was 49%. The coronary artery was normal. Atrial septal defect was not detected. Diffuse fibrosis, which may be found in the hearts of patients with Ebstein's anomaly at autopsy may have been responsible for the left ventricular depressed systolic function in this patient.

To improve the quality of life in patients with malignant diseases at the near-terminal stage, we established a system for home infusion therapy (HIT) in Osaka Prefectural Habikino Hospital in 1994. Thirty-three patients were taken care of at home using the HIT system from January, 1995 to May, 1996. Their average age was 70 years old. The duration of HIT varied from 1 to 105 days (mean:25.5 days). Twenty-four cases received parenteral nutrition. The others received agents for brain edema (4 cases), morphine hydrochloride (2 cases), and anti-fungal agents (3 case). Additionally, 63% of these patients required home oxygen therapy (HOT) with HIT. Questionnaires to their families revealed that they were afraid of the progress of the disease in patients and their physical burden became heavier after the start of HIT. However, they were quite satisfied with the results of HIT.

Doppler tissue imaging-guided pulsed Doppler echocardiography can record velocities of the regional ventricular wall, but the potential clinical applications have not yet been investigated. To propose a new modality for assessment of left ventricular wall dynamics, we investigated the longitudinal and latitudinal motions of the normal left ventricular wall with intramyocardial pulsed Doppler echocardiography under tissue imaging guidance, and characterized the velocity patterns in 31 normal subjects or normal volunteers (mean age 38 +/- 18 years old). Velocity patterns of the septal and posterior walls were recorded and compared using the parasternal and apical approaches. The apical approach showed that the entire left ventricle moved, coded in red, toward the transducer during systole, and moved away, coded in blue, during diastole. Pulsed Doppler echocardiography recorded the systolic S, early diastolic E and presystolic A waves from both windows. All three waves had higher velocities in the apical compared to the parasternal approach, and the velocities of S and E waves were increased more in the posterior wall than in the septum. Thus, the A/E ratio was significantly lower in the posterior compared to the septal wall (0.63 +/- 0.3 and 0.77 +/- 0.3, respectively, in the apical approach) and the A/E ratio of transmitral inflow was between those of the walls. Apical intramyocardial pulsed Doppler echocardiography can accurately evaluate septal and posterior wall dynamics. The present study provides important basic data for assessing regional myocardial function.

Patients with unresectable non small-cell lung cancer were treated to evaluate the toxicity and efficacy of high-dose thoracic irradiation (RT) combined with concurrent daily cisplatin plus vindesine. Fourteen evaluable patients with unresectable stage III non small-cell lung cancer treated with continuous-course RT (70 Gy in 35 fractions of 2 Gy once daily) and concurrent daily intravenous cisplatin (6 mg/m2) plus vindesine (3 mg/m2 on day 1 and day 8). The objective response rate was 86%, and two patients achieved a radiographic complete response. Leukocytopenia was the severe toxicity, but there were no episodes of discontinuation of treatment. Only one patient had grade 3 acute radiation esophagitis. Ten patients experienced late radiation pneumonitis and nine of those had grade 1 or grade 2. There was only one life-threatening case of toxicity (grade 5 pneumonitis). We concluded that the regimen of high-dose thoracic RT combined with concurrent daily cisplatin plus vindesine obtained a high response rate. Further testing on late toxicities and survival time is required.

A 68-year-old male presented with choroid plexus carcinoma in the left lateral ventricle manifesting as dysarthria and gait disturbance. Magnetic resonance imaging showed a homogeneously enhanced mass in the trigone of the left lateral ventricle. Selective left posterior cerebral arteriography showed the tumor was fed by the left medial posterior choroidal artery. Detailed examinations found no evidence of an extraneural primary focus. He underwent partial removal of the tumor followed by local Lineac irradiation (50 Gy). After irradiation, the serum level of carcinoembryonic antigen decreased and the size of the residual tumor was reduced.

Cardiothoracic ratio has been a useful index of cardiac dilatation, and a value of 50% is generally considered to indicate the upper limit of normal cardiac size. However, this value is not always correct and increases the number of false-positive results, especially in obese or older subjects who may have a misdiagnosis of cardiac enlargement. The maximal transverse diameter of the cardiac shadow of chest X-ray film consists mainly of the diameters of the left ventricle and the right atrium as shown by X-ray computed tomography, but this ratio is influenced by many factors; not only left ventricular dilatation or hypertrophy, but also dilatation of the other cardiac chambers and the aorta, rotation and shift of the heart, respiratory phase, body posture, and measurement errors. In contrast, echocardiography is an accurate method for the diagnosis of cardiac dilatation. This study correlated left ventricular dimension with cardiothoracic ratio in 80 consecutive subjects with normal physical, ECG and Doppler echocardiography examinations. There was no relationship between left ventricular end-diastolic dimension and the cardiothoracic ratio. Chest X-ray is mandatory for initial cardiac examination. However, we must be careful about roentgenographic diagnosis of cardiac dilatation. Cardiac enlargement should be diagnosed by echocardiography, but follow-up and management can be based on chest X-ray films.