Recidivism among prisoners with severe mental disorders.

Introduction: Mental disorders are common among prison inmates, with a high rate of recidivism found among those with severe mental disorders. In Japan, the number of inmates with mental disorders has been increasing with the increasing rate of recidivism. Prisoners need an uninterrupted connection to post-release support to prevent them from being incarcerated again. This study identified inmates diagnosed with mental disorders whose recidivism had recently increased to investigate recidivism among inmates with severe mental disorders and the risk factors for reincarceration. Methods: This study included 148 prisoners released from the Medical Correction Center in East Japan. Clinical diagnoses were coded using the World Health Organization's International Classification of Diseases, Tenth Revision. Risk factors focusing on the central eight items were categorized, and recidivism within 3 years of release was investigated. Result: Overall, the recidivism rate was 29.7%, with the risk of recidivism increasing by 170% in inmates with multiple incarcerations. A diagnosis of intellectual disability increased the risk of recidivism by 176%. Patients with schizophrenia were consistently less likely to recidivate than patients with other disorders. Conclusion: Intellectual disability was identified as a risk factor for recidivism, as was multiple incarcerations. These prisoners may not be connected to medical and social services and thus may not be receiving appropriate assistance. Patients with schizophrenia might be more likely to be connected to medical care and receive support after release. Further research should be conducted using these findings to prevent recidivism among inmates with mental disorders.

Shoplifting Behavior Among Patients With an Eating Disorder at a Medical Correctional Center in Japan: A Cross-Sectional Study.

Purpose: In Japan, the incarceration of patients with eating disorders (EDs) owing to repeated shoplifting has become a social issue. This study examined the shoplifting behavior of inmates with EDs at our medical correctional center, with the objective of delineating their characteristics, identifying an adequate treatment plan, and preventing recidivism. Methods: The participants consisted of 32 incarcerated patients with EDs (22 females, 10 males) charged with shoplifting, from a medical correctional center in East Japan. A cross-sectional study was employed. Data were collected by retrieving the patients' medical records and through individual interviews conducted by psychiatrists. Results: The food-specific shoplifting ED group (those who had never shoplifted anything other than food) had a core pathology of the binge-purge type of anorexia nervosa with juvenile onset (p = 0.044). Furthermore, they demonstrated an average gap of 8 years between the onset of ED and their first shoplifting episode. The non-specific shoplifting ED group (those who shoplifted food and other items) typically shoplifted before the onset of ED (p = 0.001). They experienced the onset of ED after incarceration (p = 0.004) and had comorbid disorders (p = 0.024). The food-specific group required a psychosocial approach focusing on maintaining healthy body weight and mental stability, whereas the non-specific group required multiple forms of support for substance abuse and behavioral addiction, as well as interventions to reduce impulsive behavior. Conclusion: Early intervention is necessary to improve the prognosis of patients with EDs and shoplifting behavior.

Treatment Response Distinguishes Persistent Type of Methamphetamine Psychosis From Schizophrenia Spectrum Disorder Among Inmates at Japanese Medical Prison.

Introduction: Persistent methamphetamine-associated psychosis (pMAP) is a disorder similar to schizophrenia, so much so that the differences in clinical symptoms and treatment response between the two remain unknown. In this study, we compared the features of pMAP with those of schizophrenia spectrum disorders (SSD). Materials and Methods: This was a retrospective quasi-experimental case-control study of inmates in a medical prison. The behavioral problems, clinical symptoms, and chlorpromazine (CP)-equivalent doses of 24 patients with pMAP and 27 with SSD were compared. Results: Patients in the pMAP group were hospitalized for fewer days than those in the SSD group (281.5 vs. 509.5; p = 0.012), but there were no other significant group differences in behavioral problems or clinical symptoms. The pMAP group received fewer antipsychotics in CP-equivalent doses than the SSD group at 4, 8, and 12 weeks after admission and at the time of discharge (p = 0.018, 0.001, 0.007, and 0.023, respectively). The number of CP-equivalent doses in the SSD group tended to increase after admission, but not in the pMAP group. Discussion: These findings suggest that differentiation between pMAP and SSD based on behavior and symptoms alone may be difficult, and that patients with pMAP may respond better to treatment with a lower dose of antipsychotic medication than those with SSD. Further confirmatory studies are warranted.

[Visualization of stenosis in vascular access by bubble method under carbon dioxide (CO2) angiographic procedures].

A percutaneous transvascular angioplasty (PTA) is performed to relieve failed vascular access for hemodialysis. Angiography using non-ionic iodinated contrast media is the imaging modality of choice for performing PTA. However, the use of iodinated contrast media is contraindicated for patients with a history of iodine allergy. Since 1920, carbon dioxide (CO(2)) has been used as a safe contrast medium in various studies. In CO(2) shunt angiography for hemodialysis, visualization of the vascular structures was often suboptimal due to shunt-specific conditions, such as rapid flow and narrow diameter of the vessels. In the present report, we attempted an improvement of the visualization by injection of CO(2) bubbles in view of the properties of CO(2) (floating and low viscosity). The results indicated that the CO(2) bubbles angiography clearly demonstrated the narrow vessels and stenotic portions that were not visualized by conventional CO(2) angiography. In addition, the required volume of CO(2) could be reduced in comparison with previous studies in the literature. Therefore, the method seemed to be effective in reducing exposure and preventing complication by CO(2). Thus, CO(2) bubbles angiography may be useful for shunt angiography and sequential angioplasty when experiencing shunt problems.

Radioanatomical study of the bronchovascular anomalies of the middle and lower lobes of the right lung using multidetector computed tomography.

OBJECTIVE: Preoperative evaluation of bronchovascular structures is useful for prevention of accidents in pulmonary lobectomy. The purpose of this study was to examine the frequency and multidetector computed tomographic (CT) appearances of bronchovascular anomalies between the right middle and lower lobes. METHODS: A total of 1116 consecutive chest CT examinations were analyzed in the present study. On display, the bronchovascular anomalies between the right middle and lower lobes were searched. When anomalous structures were observed, 3-dimensional images were reconstructed. RESULTS: Sixty-seven cases (6.0%) with anomalous findings were observed. In 20 cases (1.79%), the right middle lobe bronchus and artery supplied the lower lobe, whereas the lower lobe artery supplied the right middle lobe in 46 cases (4.12%). In 1 case (0.09%), the 2 patterns previously mentioned were observed concomitantly. CONCLUSIONS: Anomalous bronchovascular structures between the right middle and lower lobes were identified by a multidetector CT with an incidence of 6.0%. Knowledge of the frequency and CT features is useful for preoperative CT evaluation.

Conformational flexibility of the N-terminal domain of apolipoprotein a-I bound to spherical lipid particles.

Lipid binding of human apolipoprotein A-I (apoA-I) occurs initially through the C-terminal alpha-helices followed by conformational reorganization of the N-terminal helix bundle. This led us to hypothesize that apoA-I has multiple lipid-bound conformations, in which the N-terminal helix bundle adopts either open or closed conformations anchored by the C-terminal domain. To investigate such possible conformations of apoA-I at the surface of a spherical lipid particle, site-specific labeling of the N- and C-terminal helices in apoA-I by N-(1-pyrene)maleimide was employed after substitution of a Cys residue for Val-53 or Phe-229. Neither mutagenesis nor the pyrene labeling caused discernible changes in the lipid-free structure and lipid interaction of apoA-I. Taking advantage of a significant increase in fluorescence when a pyrene-labeled helix is in contact with the lipid surface, we monitored the behaviors of the N- and C-terminal helices upon binding of apoA-I to egg PC small unilamellar vesicles. Comparison of the binding isotherms for pyrene-labeled apoA-I as well as a C-terminal helical peptide suggests that an increase in surface concentration of apoA-I causes dissociation of the N-terminal helix from the surface leaving the C-terminal helix attached. Consistent with this, isothermal titration calorimetry measurements showed that the enthalpy of apoA-I binding to the lipid surface under near saturated conditions is much less exothermic than that for binding at a low surface concentration, indicating the N-terminal helix bundle is out of contact with lipid at high apoA-I surface concentrations. Interestingly, the presence of cholesterol significantly induces the open conformation of the helix bundle. These results provide insight into the multiple lipid-bound conformations that the N-terminal helix bundle of apoA-I can adopt on a lipid or lipoprotein particle, depending upon the availability of space on the surface and the surface composition.

Analysis of respiration-related movement of upper abdominal arteries: preliminary measurement for the development of a respiratory motion compensation technique of roadmap navigation.

In this study, we analyzed the respiratory motion of the upper abdominal arteries preliminary to developing a method of respiratory motion correction for the roadmap technique used in vascular interventions. We retrospectively obtained six digital angiography sequences taken during respiration. The levels of the right and left hemidiaphragms and the positions of artery bifurcation points were measured manually through each sequence. Artery bifurcation points were classified as the hepatic artery group (HAG), splenic artery group (SAG), and celiac group (CG). Correlations between the motions of each hemidiaphragm and of the artery bifurcation points in each group were determined. We found that the vertical motion of the HAG and CG matched that of the right hemidiaphragm (r = 0.924 and r = 0.888, respectively). The vertical motion of the SAG matched that of the left hemidiaphragm (r = 0.949). The mean horizontal movements for all groups were up to 1.90 mm. The vertical motion for each group matched that of the right or the left hemidiaphragm. These findings will facilitate the development of a method of respiratory motion correction for the roadmap technique.

[Usefulness of the classification technique of cerebral artery for 2D/3D registration.].

Several papers have proposed 2D/3D registration methods of the cerebral artery using magnetic resonance angiography (MRA) and digital subtraction angiography (DSA). Since differences between vessels in a DSA image and MRA volume data cause registration failure, we previously proposed a method to extract vessels from MRA volume data using a technique based on classification of the cerebral artery. In this paper, we evaluated the usefulness of this classification technique by evaluating the reliability of this 2D/3D registration method. This classification method divides the cerebral artery in MRA volume data into 12 segments. According to the results of the classification, structures corresponding to vessels on a DSA image can then be extracted. We applied the 2D/ 3D registration with /without classification to 16 pairs of MRA volume data and DSA images obtained from six patients. The registration results were scored into four levels (Excellent, Good, Fair and Poor). The rates of successful registration (> fair) were 37.5% for registration without classification and 81.3% for that with classification. These findings suggested that there was a low percentage of incorrectly extracted voxels and we could facilitate reliable registration. Thus, the classification technique was shown to be useful for feature-based 2D/ 3D registration.

[Basic and clinical studies of visualizing right inferior phrenic artery by multi detector row-CT].

To perform transcatheter arterial embolization (TAE) successfully, it is important to obtain information about parasitic arterial supply to the hepatocellular carcinoma (HCC). Among these extrahepatic collateral vessels, the right inferior phrenic artery (RIPA) is the most frequent and important extrahepatic collateral artery supplying the HCC. In the present study, we obtained multi-planar reformation (MPR) images of RIPA using multi detector row computed tomography (MDCT), assessed the ability of MDCT to demonstrate the origin of RIPA, and then analyzed the morphology of the origin. In a basic study using an original phantom simulating vessel origin, the origin was poorly visualized depending on the phantom diameter and angle of the origin to the scanned section. A clinical study was performed in 28 patients with HCC who underwent both MDCT and angiography within a short period. In 19 of 28 patients, RIPA originated at the celiac artery. In 3 patients, RIPA originated at the right renal artery, and in 6, directly at the abdominal aorta. The origin of RIPA was categorized into four patterns according to the inclination of the origin on transverse sections of MDCT. RIPA that originated at the right renal artery and showed an upward course perpendicular to the scan section of MDCT were most clearly visualized at the origin. In addition, RIPA could be observed in an optional direction on the workstation. Pre-angiographic visualization of the origin of RIPA may save angiographic time, curtail contrast medium, and reduce radiation exposure.

Automatic anatomical labeling method of cerebral arteries in MR-angiography data set.

To improve the accuracy and robustness of 2D/3D registration of digital subtraction angiography images and magnetic resonance angiography (MRA) data, we have developed an automatic method for anatomical labeling of the cerebral arteries in MRA data. The anatomical labeling method is a location-based method which segments an artery tree to branches and classifies the branches into labeled segments, i.e., internal carotid arteries (ICA), basilar artery (BA), middle cerebral arteries (MCA), A1 segments of the anterior cerebral artery (ACA(A1)), other segments of the anterior cerebral artery (ACA), posterior communication arteries (PcomA) and posterior cerebral arteries (PCA), according to their location. Arteries were extracted from MRA data for this labeling method by the region-growing technique. Fifteen cases were examined to evaluate the method accuracy. The number of correctly segmented voxels in each artery segment was determined, and the correct labeling percentage was calculated based on the total number of voxels of the artery. Mean percentages were as follows: ACA, 82.7%; Right (R-) ACA(A1), 47.1%; Left (L-) ACA(A1), 46.1%; R-MCA, 80.4%; L-MCA, 74.1%; R-PcomA, 0.0%; L-PcomA, 3.3%; R-PCA, 60.3%; LPCA, 66.9%; R-ICA, 90.7%; L-ICA, 90.7%; BA, 89.9%; and total arteries, 84.1%. The ACA, MCA, ICA and BA were consistently identified correctly.

[Visualization of the lower cranial nerves by 3D-FIESTA].

MR cisternography has been introduced for use in neuroradiology. This method is capable of visualizing tiny structures such as blood vessels and cranial nerves in the cerebrospinal fluid (CSF) space because of its superior contrast resolution. The cranial nerves and small vessels are shown as structures of low intensity surrounded by marked hyperintensity of the CSF. In the present study, we evaluated visualization of the lower cranial nerves (glossopharyngeal, vagus, and accessory) by the three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequence and multiplanar reformation (MPR) technique. The subjects were 8 men and 3 women, ranging in age from 21 to 76 years (average, 54 years). We examined the visualization of a total of 66 nerves in 11 subjects by 3D-FIESTA. The results were classified into four categories ranging from good visualization to non-visualization. In all cases, all glossopharyngeal and vagus nerves were identified to some extent, while accessory nerves were visualized either partially or entirely in only 16 cases. The total visualization rate was about 91%. In conclusion, 3D-FIESTA may be a useful method for visualization of the lower cranial nerves.

Tracking technique of a micro guide wire in sequential fluorograms.

In this paper, we propose a tracking technique for a micro guide wire in a sequence of fluorograms. A technique in which the region-growing technique was embedded was developed. It gives the center line of a micro guide wire. A sequence of 1,024 x 1,024 x 16 bit fluorograms (111 frames) with a carotid phantom and head phantom was obtained with a CAS-8000V (Toshiba America Medical Systems, Inc., CA, USA) C-arm angiography system and a Hi-Torque Standard micro guide wire (Advanced Cardiovascular Systems, Inc., CA, USA). To evaluate the technique, we manually traced the guide wire in each sequence frame three times, and a "true" single-width micro guide wire was created from them. The number of pixels on the true guide wire and inside the two-pixel tolerance of the center line was counted in each fluorogram, and the percentage of that count based on the number of all pixels on the true guide wire was calculated as true positive (TP). In addition, the number of pixels on the center line and outside the two-pixel tolerance of the true guide wire was counted in each frame as false positive (FP). The tracking technique has a mean TP of 94.8% and a mean FP of 5.1 pixels/frame. Several frames have low TP and high FP, but the technique could continue to track the micro guide wire until the end of the sequence. We therefore concluded that we had developed an accurate automatic tracking technique for micro guide wires in fluoroscopic sequences.