The impact of cardiac surgery in patients with trisomy 18 and trisomy 13 in Japan.

Congenital heart defects (CHD) are very common in patients with trisomy 18 (T18) and trisomy 13 (T13). The surgical indication of CHD remains controversial since the natural history of these trisomies is documented to be poor. To investigate the outcome of CHD in patients with T18 and T13, we collected and evaluated clinical data from 134 patients with T18 and 27 patients with T13 through nationwide network of Japanese Society of Pediatric Cardiology and Cardiac Surgery. In patients with T18, 23 (17%) of 134 were alive at this survey. One hundred twenty-six (94%) of 134 patients had CHDs. The most common CHD was ventricular septal defect (VSD, 59%). Sixty-five (52%) of 126 patients with CHD developed pulmonary hypertension (PH). Thirty-two (25%) of 126 patients with CHD underwent cardiac surgery and 18 patients (56%) have survived beyond postoperative period. While palliative surgery was performed in most patients, six cases (19%) underwent intracardiac repair for VSD. Operated patients survived longer than those who did not have surgery (P < 0.01). In patients with T13, 5 (19%) of 27 patients were alive during study period. Twenty-three (85%) of 27 patients had CHD and 13 (57%) of 27 patients had PH. Atrial septal defect was the most common form of CHD (22%). Cardiac surgery was done in 6 (26%) of 23 patients. In this study, approximately a quarter of patients underwent surgery for CHD in both trisomies. Cardiac surgery may improve survival in selected patients with T18.

Effect of carvedilol on heart failure in patients with a functionally univentricular heart.

BACKGROUND: The effect of carvedilol on heart failure (HF) in patients with a functionally univentricular heart (UVH) remains unclear. METHODS AND RESULTS: Carvedilol was used to treat HF in 51 patients with a UVH, classified into 3 groups: after the Fontan operation (F), after the bidirectional Glenn operation (G), and patients who had not undergone Fontan or Glenn operation (NF). Carvedilol therapy was started at a mean age of 10 ± 12 years (range: 1 month to 34 years). The initial and maximum doses of carvedilol were 0.04 ± 0.03 and 0.42 ± 0.29 mg · kg(-1) · day(-1), respectively. After a mean follow-up of 11 months, the cardiothoracic ratio improved from 60 ± 8 to 58 ± 8% (P<0.01), and the dosage of furosemide was reduced from 1.4 ± 0.9 to 0.7 ± 0.7 mg · kg(-1) · day(-1) (P < 0.01). The ejection fraction also improved from 35 ± 12 to 40 ± 11% (P < 0.05), and this improvement was prominent in the F group (from 35 ± 15 to 45 ± 9%; P < 0.05). Clinical signs, symptoms, and New York Heart Association functional class also improved. CONCLUSIONS: Carvedilol may play an important role in treating HF associated with a UVH.

Efficacy and safety of carvedilol for heart failure in children and patients with congenital heart disease.

There have been few reports describing the use of carvedilol in children or patients with congenital heart disease. Therefore, its optimal regimen, efficacy, and safety in these patients have not been adequately investigated. Subjects were 27 patients with two functioning ventricles, for whom carvedilol was initiated (from December 2001 to December 2005) to treat heart failure. All patients had failed to respond to conventional cardiac medication. They consisted of 12 males and 15 females, aged 23 days to 47 years (median age: 2 years). Heart failure due to ischemia (myocardial infarction, intraoperative ischemic event) or due to myocardial disease (cardiomyopathy, myocarditis), and heart failure with atrial or ventricular tachyarrhythmia represented 70% of all cases. Carvedilol was initiated at a dose of 0.02-0.05 mg/kg/day, which was increased by 0.05-0.1 mg/kg/day after 2 days, 0.1 mg/kg/day after 5 days, and 0.05-0.1 mg/kg/day every month thereafter with a target dose of 0.8 mg/kg/day. This study retrospectively assessed the efficacy and adverse reactions based on changes of symptoms, cardiothoracic ratio (CTR), left ventricular ejection fraction (LVEF), and human atrial natriuretic peptide (hANP)/b-type natriuretic peptide (BNP) blood levels. The mean follow-up period was 10.2 months (range: 1-46 months). Twenty-six (96.3%) patients showed improvement in symptoms and were discharged from the hospital. However, the remaining one patient failed to respond and died. Significant cardiovascular adverse reaction was seen in none of the patients. The mean CTR decreased from 61.8% +/- 5.3% before treatment to 57.6% +/- 7.4% after treatment (P < 0.05, n = 25), and the mean LVEF improved from 41.4% +/- 23.1% to 61.1% +/- 10.1% (P < 0.05, n = 10), respectively. Mean hANP and BNP levels showed a decrease from 239.1 pg/ml to 118.3 pg/ml and a significant decrease from 437.9 pg/ml to 120.5 pg/ml, respectively (P < 0.05, n = 10). Improvements in these data were also demonstrated when analyzed individually among the pediatric group (aged younger than 18) and the congenital heart disease group. Initiation of carvedilol at a lower dose with more gradual dose escalation, compared with previously reported regimens, might have efficacy with low incidence of adverse effects in pediatric patients and patients with congenital heart disease. Carvedilol may be effective in treating heart failure in children due to ischemia, myocardial disease, and complicated by tachyarrhythmia.

Impact of pretilachlor herbicide and pyridaphenthion insecticide on aquatic organisms in model streams.

To detect the impact of pesticides on aquatic organisms, model streams (3m wide, 20 m long) were established in paddy field in Japan. More than 100 species of aquatic organisms were generated in the model streams. Field tests with pretilachlor herbicide and pyridaphenthion insecticide were carried out in the streams for 3 yr (2001-2003). Exposure of pretilachlor (max. 0.382 mg/L) showed little density changes in algae with a Bray-Curtis percent similarity in the range 81.6-93.3% for algae. Exposure to high concentrations (>0.1mg/L) of pyridaphenthion produced visible density reductions in Cladocera zooplankton species. Reduction of individual aquatic insects in the model streams by pyridaphenthion caused an increase of chlorophyll a greater than that of the control streams. The pesticides used showed no substantial differences in the ecosystems of model streams exposed to maximum environmental concentrations (e.g., 0.01 mg/L) detected in real rivers.

Effectiveness of carvedilol for congestive heart failure that developed long after modified Fontan operation.

We report a case of a patient with severe heart failure after Fontan procedure in whom carvedilol was very effective. A 27-year-old man had intractable congestive heart failure due to severe ventricular dysfunction after Fontan operation. Central venous pressure was elevated to 29 mmHg. A right-to-left shunt was noted across a large collateral vessel between the innominate vein and the pulmonary vein. He was administered carvedilol (initial dose, 2 mg/day; maximum dose, 30 mg/day). Cardiac catheterization performed 1 year after carvedilol administration revealed a decrease in atrial pressure and improvement of ventricular function. He underwent a conversion operation to total cavopulmonary connection (TCPC) and ligation of a collateral vein communicating with the innominate and pulmonary veins. Carvedilol may be a legitimate treatment before TCPC conversion or heart transplantation for the high-risk group of patients with a failed Fontan circulation.

[Examination of susceptibility artifact in three-dimensional gadolinium-enhanced chest MR angiography].

Signal loss that is sometimes found in the subclavian artery during chest MR angiography is thought to be caused by the susceptibility effect of highly concentrated contrast medium. In our research project, we examined the conditions under which signal loss occurs. We made vessel phantoms (artery phantom, vein phantom) that contained different concentrations of Gd-DTPA water solutions, and placed them in a 0.5 mmol/l Gd-DTPA water solution. We examined signal loss when the vein phantom was parallel to the magnetic field and when it was perpendicular to the magnetic field. We found that there was no signal loss in the artery phantom when the vein phantom was parallel to the magnetic field. In contrast, signal loss occurred in the artery phantom when the vein phantom was perpendicular to the magnetic field. The higher the concentration in the vein phantom, the closer the distance to the vessel phantom, and the longer the echo time (TE), the greater was the signal loss. Thus, the cause of signal loss in the subclavian artery was found to be the perpendicular orientation of the subclavian vein (through which the highly concentrated contrast medium flows) to the magnetic field. With the MRI devices currently in use, perpendicular orientation of the subclavian vein to the magnetic field cannot be avoided. Furthermore, the subclavian vein and subclavian artery are anatomically in close proximity to one another. These factors cause the susceptibility artifact, which is thought to result in signal loss in the subclavian artery.

Effect of temperature on life history of the predatory mite Amblyseius (Neoseiulus) californicus (Acari: Phytoseiidae).

Amblyseius (Neoseiulus) californicus is an indigenous mite in Japan that feeds on many spider mite species. We evaluated the development, survivorship and life-history parameters of A. californicus on a diet of eggs of Tetranychus urticae (red form). More than 97.3% of A. californicus eggs hatched and more than 81.6% of newly hatched larvae attained maturity at temperatures between 15 and 35 degrees C. Females oviposited at 37.5 degrees C, but no eggs hatched. At 40 degrees C, no females laid eggs. The lower threshold temperature from egg to oviposition was 10.3 degrees C and the thermal constant was 86.2 degree-days. Based on these data, the maximum number of generations that could complete development in a year under field conditions in Ibaraki, central Japan, would be between 21 and 28. At 25 degrees C, females laid a mean of 41.6 eggs during a mean oviposition period of 19.4 days. The intrinsic rates of natural increase (rm) were 0.173 at 20 degrees C, 0.274 at 25 degrees C and 0.340 at 30 degrees C.

Molecular cloning of a D-cycloserine resistance gene from D-cycloserine-producing Streptomyces garyphalus.

A 3.5-kb DNA fragment that confers resistance to D-cycloserine (DCS) was cloned from the chromosomal DNA of a DCS-producing Streptomyces garyphalus into Streptomyces lividans by a shot-gun cloning technique. Nucleotide sequence analysis revealed the existence of four open reading frames (ORFs B, C, D, and E), together with two incomplete ORFs, A and F. By introduction of the cloned fragment into Escherichia coli, the host obtained resistance to DCS. We showed that ORF B, which consists of 903 bp, is a DCS resistance gene. The hydropathy plot analysis of a protein deduced from ORF B revealed that the protein carries membrane-integral domains spanning the membrane 10 times, which suggests that the DCS-resistance determinant may be a factor associated with DCS transport.

Subject independent facial expression recognition with robust face detection using a convolutional neural network.

Reliable detection of ordinary facial expressions (e.g. smile) despite the variability among individuals as well as face appearance is an important step toward the realization of perceptual user interface with autonomous perception of persons. We describe a rule-based algorithm for robust facial expression recognition combined with robust face detection using a convolutional neural network. In this study, we address the problem of subject independence as well as translation, rotation, and scale invariance in the recognition of facial expression. The result shows reliable detection of smiles with recognition rate of 97.6% for 5600 still images of more than 10 subjects. The proposed algorithm demonstrated the ability to discriminate smiling from talking based on the saliency score obtained from voting visual cues. To the best of our knowledge, it is the first facial expression recognition model with the property of subject independence combined with robustness to variability in facial appearance.

[Examination of MR cholangiopancreatography using the fast recovery single shot fast spin echo sequence].

During this project, we evaluated methods to scan MRCP images with overlapping slice positions during one breath-hold using the FRSSFSE sequence. The FRSSFSE sequence is a technique to arbitrarily change the residual transverse magnetization to longitudinal magnetization. With the SSFSE sequence, the imaging field where the slice position overlaps is subject to substantial influence from the saturation effect of the water component. Therefore, one breath-hold is required for each image. However, the FRSSFSE sequence enabled the deterioration in image quality due to the saturation effect to be minimized even during a short TR. This enabled images of overlapping slice positions to be scanned during one breath-hold. We used a setting of TR=5,000 ms at our hospital, and scanned several images with overlapping slice positions during one breath-hold. The TR=5,000 ms setting was determined from image quality and breath-hold time considerations. The use of the FRSSFSE sequence with MRCP enabled 3-4 images to be scanned at overlapping slice positions during one breath-hold. This method is effective in reducing examination time and the burden on the patient.

[Removal of high signal artifact (marching metal artifact) by the magnetic substance].

During this project, we evaluated methods to prevent high-signal artifact (marching metal artifact) that are caused by magnetic substance. Marching metal artifact is caused by the resonance frequency created by magnetic substance. Phase encoding and frequency encoding are often switched to minimize the influence that marching metal artifact have on the image. However, this method will only change the position at which marching metal artifact occur. It does not have the ability to completely prevent marching metal artifact. Our research illustrated that marching metal artifact can be prevented by changing the strength of the slice selective gradient field at the 90 degree RF pulse and 180 degree RF pulse. In other words, marching metal artifact can be prevented by changing the frequency bandwidth for the 90 degree RF pulse and 180 degree RF pulse. The incorporation of the phase correct option in the device used for our research (SIGNA LX and SIGNA CV/i) results in different slice selective gradient field strengths at the 90 degree RF pulse and the 180 degree RF pulse. This indicates that the use of phase correction enables marching metal artifact to be prevented.