Editorial
Message from the New Editor-in-Chief
NOBUYUKI HAMAJIMA
pg(s) 97- 99
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Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Previous studies have indicated that joint instability from ligament insuffi ciency is the pathological mechanism underlying the disease. Therefore, various ligament reconstruction techniques have been developed to improve both the stability and kinematics of the joint. However, none of them involve anatomical ligament reconstruction and are almost always used in combination with trapeziectomy. In order to restore joint stability as well as to save the trapezium, we developed a new technique for reconstructing the anterior oblique ligament of the TMC joint anatomically using the distal part of the transverse carpal ligament. In this article, we describe the technique in detail and report the clinical outcome of 9 patients. 6 of whom were treated by ligament reconstruction alone while the other 3 underwnet ligament reconstruction combined with surface joint replacement. All 9 patients maintained good stability and ROM of the joint at their fi nal follow-up (3 years or longer). Although that follow-up period is admittedly short, we think anatomical ligament reconstruction with or without surface joint replacement is a rational alternative to ligament reconstruction tendon interposition (LITI) prodecures.
Invited Review Articles
Chemotherapy Using Intra-Arterial Infusion for Oral Cancer
IWAI TOHNAI
pg(s) 101- 108
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There are three historically recognized methods of intra-arterial infusion for oral cancer: Conventional intra-arterial infusion via the superfi cial temporal artery: Superselective intra-arterial infusion via the femoral artery (Seldinger method), New superselective intra-arterial infusion via the superfi cial temporal artery. Here we report a recent instance of daily concurrent chemoradiotherapy using a new superselective intra-arterial infusion. A catheter with a curved tip was inserted superselectively into the feeding artery of the tumor via the superfi cial temporal artery (long-term catheterization has become possible using this method). The patient with T3 tongue cancer was treated by chemoradiotherapy. Radiotherapy (total dose: 40 Gy/4weeks) and superselective intra-arterial infusion chemotherapy using docetaxel (DOC) (total dose: 60 mg/m2/4weeks, 15 mg/m2/ week) and cisplatin (CDDP) (total dose: 100 mg/m2/4weeks, 5 mg/m2/day) were concurrently performed daily, followed by surgery, after which no major complication was observed. The clinical effect was complete response (CR), and the pathological effect on the resected tumor after surgery was pathological CR. This method promises to be a new strategy of choice for the treatment of oral cancer.
Influence of Age and Sex on High-Fat Diet-induced Increase in Blood Pressure
KAZUMASA UEMURA and NORIKA (TAMAYA) MORI
pg(s) 109-114
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We are studying to elucidate the reason for increase in age-related hypertension and the mechanism thereof using rats. We would like to introduce model animals and the results obtained from these animal experiments. Based on a study regarding whether the elevation of blood pressure caused by dietary fat is due to excessive calorie intake and resulting body-weight gain or else fat itself - if so which type of fat is responsible for elevating blood pressure, it was suggested that elevated blood pressure was due to some effects specifi c to animal fat. According to a study if insulin resistance involves elevated blood pressure, it became apparent that the build-up of visceral fat caused by high-fat diet together with worsening of insulin sensitivity were responsible for elevating blood pressure. Next, we studied if there are sexual differences in dietary-fat induced hypertension and infl uence of male hormone. It became clear that the mechanism of elevated blood pressure caused by high-fat diet involved a condition of insulin resistance due to high-fat diet and furthermore, only when testosterone was present, the blood pressure was elevated. In addition, we studied aging effects on hypertension due to dietary fat. As a result, it became clear that the older the person gets, more likely he/she suffers from visceral obesity and conditions of insulin resistance, making blood pressure prone to rise. In summary, even without having excessively high calorie diet and without body weight gain, intake of excessive animal fat will cause visceral obesity and so do hypertension. Also, when taking high-fat diet, males tend to suffer from hypertension more often than females, suggesting testosterone is involved as the cause. Further, it was shown that the older the persons are, the greater the dietary effects result in, causing their blood pressures likely to increase.
Original Papers
Influence of Monitor Luminance and Room Illumination on Soft-Copy Reading Evaluation with Electronically Generated Contrast-Detail Phantom: Comparison of Cathode-Ray Tube Monitor with Liquid Crystal Display
HIDEYUKI MURAMOTO, KAZUHIRO SHIMAMOTO, MITSURU IKEDA, KAZUYUKI KOYAMA, HIROMICHI FUKUSHIMA and TAKEO ISHIGAKI
pg(s)115-120
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The infl uence of monitor brightness and room illumination on soft-copy diagnosis by both cathode-ray tube (CRT) monitor and liquid crystal display (LCD) was evaluated and compared using a contrast-detail phantom. Nine observers (7 radiologists and 2 radiological technicians) interpreted six types of electronically generated contrast-detail phantom images using a 21-inch CRT (2,048×2,560) and a 21-inch LCD (2,048×2,560) under 6 kinds of viewing conditions, i.e. monitor brightness of 330 cd/m2 or 450 cd/m2, and room illumination of 20, 100 or 420 lux at the center of the display. Observers were requested to determine the visible borderline of the objects. Between 330 cd/m2 and 450 cd/m2, no signifi cant difference in the visible area was found under any of the three lighting conditions. However, in two low-contrast phantom images, the visible area on the LCD was signifi cantly larger than that on the CRT, independent of both monitor brightness and room illumination. (p<0.05). The effect of room illumination was not signifi cant, suggesting that the use of LCD at high room illumination is acceptable.
Factors Related to Frequency of Engaging in Outside Activities among Elderly Persons Living an Independent Life at Home
MIYUKI ISHIKAWA, KOJI TAMAKOSHI, HIROSHI YATSUYA, KAZUTAKA SUMA, KEIKO WADA, REI OTSUKA, KUNIHIRO MATSUSHITA, HUIMING ZHANG, CHIYOE MURATA, TAKAAKI KONDO and HIDEAKI TOYOSHIMA
pg(s)121-130
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We examined by cross-sectional design the association between the frequency of outside activity and the demographic, health problem, lifestyle, psychosocial and environmental factors among 239 community- dwelling elderly Japanese people (105 men and 134 women) aged 65 years and older, who lived independently at home. The associations of the outside activities more than 6–7 days per week based on a categorical questionnaire choice with potential factors were expressed by odds ratio (OR) and 95% confi dence interval (CI) calculated through logistic regression analysis by sex. The proportions of those engaging in outside activity more than 6–7 days per week were 38.1% and 21.6% among men and women, respectively. The associations of the factors belonging to various fi elds with the frequency of engaging in outside activities were clearly pronounced among men. Elderly men engaging in outside activities more often were scored less for depression and more socially active than men engaging in outside activities less often. Multiple regression analysis revealed meeting and talking often with friend (OR=4.18, 95% CI: 1.06–16.5), current alcohol consumption (3.01, 1.06–8.54), having any hobby (3.59, 0.94–13.7), and easy access to public transportation (3.43, 1.28–9.16) as signifi cant or borderline signifi cant factors related to engaging in outside activities more than 6−7 days per week. Women who were currently employed engaged in outside activities more frequently. The frequency of engaging in outside activities was associated with factors belonging to various fi elds among elderly people living independently, particularly among men, suggesting its usefulness as an indicator of comprehensive well-being.
Evaluation of New Image Processing Conditions for Digital Mammograms from Fuji Computed Radiography
HIROSHI KANO, TOKIKO ENDO, MITSURU IKEDA, MIKINAO OIWA and TAKEO ISHIGAKI
pg(s)131-138
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Purpose: A new processing parameter (T-type parameter) setting for gray scale was developed to improve the image quality of digital mammograms. To clarify the usefulness of this parameter setting, we have evaluated the image quality of digital mammograms (hard copy images) processed with this parameter, and compared it with S/F mammography. Material and Methods: Mammograms were made under the same radiographic conditions by the S/F and FCR systems (type 1, S/F; type 2 and 3, FCR with new T-type parameters; type 4 and 5, FCR with conventional parameters). A total of 49 images from 10 cases was selected for evaluation testing. Evaluation items were the contrast visibility of mammary glands and adipose tissues together with their granularity and sharpness. Eleven medical doctors participated in evaluating the images. Results: The FCR hard copy images processed with the T-type parameter settings were signifi cantly preferred over the conventional S/F images for the contrast visibility of mammary glands and adipose tissue. As for the other items (except for granularity), the FCR hard copy images processed with the T-type parameter settings were subjectively evaluated as slightly better than or equal to the S/F images. In contrast, the conventional S/F images were signifi cantly preferred over the FCR hard copy images processed with the conventional parameter settings. Conclusion: The image quality of FCR hard copy images processed with the T-type parameter settings was preferred over that of conventional S/F images as evaluated by medical doctors who specialized in mammography interpretation.
Application of Subsecond Rotation Scan to Helical CT for Lung Cancer Screening
YOSHINE MORI, SHIGEKI ITOH, MITSURU IKEDA, AKIKO SAWAKI, KOUJIRO SUZUKI, SHINGO IWANO, HIROKO SATAKE, SHOJI ARAHATA, TOYOHIRO OTA and TAKEO ISHIGAKI
pg(s)139-145
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Purpose: To clarify whether the benefi t of a reduced effective scan width obtained using a smaller pitch outweighs the disadvantage of increased noise in the application of a subsecond helical CT to mass screenings for lung cancer. Materials and Methods: Twenty-two helical CT scans of the lung were obtained in 11 healthy subjects using the following parameters: 1) scan 1 was performed at 120 kVp, 50 mA, 10-mm collimation, 1- second/rotation, helical pitch of 2.0; and 2) scan 2 was performed at 120 kVp, 50 mA, 10-mm collimation, 0.75-second/rotation, helical pitch of 1.5. Computer-generated nodules measuring 10 mm and 6 mm in diameter showing ground-glass opacity were superimposed on these images. The detectability of each nodule was evaluated by six blinded readers using ROC analysis. Results: Detectability of the 6-mm nodules was signifi cantly higher in scan 2 than in scan 1. Detectability of the 10-mm nodules was not signifi cantly different between scans 1 and 2. Conclusion: The use of a smaller pitch by employing a subsecond rotation scan in a helical CT for lung cancer screenings improves the detection of small lesions without increasing either the scanning time or radiation dose.
Intra- and Interobserver Agreement and Performance Score of Breast Phantom Image Interpretation: Influence of Ambient Room Lighting Levels
KAZUYUKI KOYAMA, KAZUHIRO SHIMAMOTO, MITSURU IKEDA, HIDEYUKI MURAMOTO, HIROKO SATAKE, AKIKO SAWAKI, KATSUHIKO KATO, HIROMICHI FUKUSHIMA and TAKEO ISHIGAKI
pg(s)147-153
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The influence of ambient room lighting conditions on soft-copy breast phantom image interpretation was evaluated by comparing cathode ray tube (CRT) monitors with liquid crystal displays (LCDs). Nine observers were asked to use a three-point scale to rate the visibility of various phantom objects (masses, specks, and fi bers) displayed on a 21-inch CRT (2,560 × 2,048) and a 21-inch LCD (2,560 × 2,048) under three different levels of ambient lighting (20, 100 and 420 lux at the display center). Each phantom image was interpreted twice, and the reproducibility of judgment and inter-observer agreement was evaluated using kappa statistics. Except for the “mass” score, the LCD score showed a signifi cantly higher value (p<0.05) compared with that of CRT. Nevertheless, no signifi cant differences were found among the three lighting levels. Furthermore, intra- and inter-observer agreement in judgments showed no effects of room illumination. Although the breast phantom objects were better visualized on LCDs than on CRT monitors, room illumination did not affect the performance score of soft-copy reading.
Impaired Insulin-Regulated Membrane Aminopeptidase Translocation to the Plasma Membrane in Adipocytes of Otsuka Long Evans Tokushima Fatty Rats
MIKIHITO TAKEUCHI, ATSUO ITAKURA, MAYUMI OKADA, SHIGEHIKO MIZUTANI and FUMITAKA KIKKAWA
pg(s)155-163
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Insulin-regulated membrane aminopeptidase (IRAP) translocates to the plasma membrane with glucose transporter-4 (GLUT4) on insulin stimulation. However, this may be impaired in patients at risk of diabetes. Recently a novel technique has been developed to assess cell surface IRAP activity dynamically using a fl uorogenic membrane impermeable substrate. In this study we measured the cell surface IRAP activity and 3-0-[methyl-14C]-D-Glucose uptake in adipocytes isolated from Otsuka Long Evans Tokushima Fatty rats (OLETF), developed as a model of type 2 diabetes mellitus, to evaluate whether the translocation of GLUT4/IRAP vesicles is affected. On the addition of insulin, the cell surface IRAP activity promptly increased to reach equilibrium in a hormone dose-dependent manner. OLETF rats showed signifi cantly lower equilibrium activity than control rats (P<0.01). Time to reach the equilibrium was also signifi cantly longer in the OLETF case, and adipocytes isolated from OLETF rats demonstrated both a delay and a reduction in 3-0-[methyl-14C]-D-Glucose uptake. This impairment in all parameters was alleviated by treatment with pioglitazone. Continuous measurement of cell surface IRAP activity allowed accurate evaluations of GLUT4/IRAP vesicle translocation and of the establishment of defects in OLETF rats.
