永井 良三

Metabolic syndrome is a major risk factor of cardiovascular events, and obese visceral adipose tissue remodeling and malfunctioning based on chronic inflammation play a central role. To assess dynamic multi-cellular interplay, a novel ex vivo and in vivo adipose tissue imaging method was developed. We found close spatial and temporal interrelationships between angiogenesis and adipogenesis, and both were augmented in obese adipose. In addition, we found increased leukocyte-platelet-endothelial cell interactions in the microcirculation of obese visceral adipose that were indicative of activation of the leukocyte adhesion cascade, a hallmark of inflammation. Both macrophages and endothelial cells showed increased adhesion molecules, and platelets were also activated locally in obese adipose. Up-regulated expression of adhesion molecules on multiple cell types suggests that their increased interactions contribute to local activation of inflammatory processes within visceral obese adipose tissue. Interestingly, the heightened leukocyte-platelet-endothelial interactions were not observed in obese subcutaneous fat pads. Our results demonstrated the power of our imaging technique to analyze complex cellular interplays in vivo and to evaluate new therapeutic interventions against them. Results also indicate that visceral obese adipose tissue is an inflammatory site itself.

The objective of this study was to evaluate the efficacy of the Integrating the Healthcare Enterprise (IHE) Echocardiography profile in an environment that included legacy information systems. For this study, we developed an Ultrasound Image and Report Management System that was capable of supporting the IHE echocardiography profile. We then implemented this system at the real clinical environment and integrated it with the existing legacy hospital information system, department system, and picture archive and communication system (PACS). A gateway interface was used to convert the proprietary protocol and data from the legacy systems to support the standard HL7 data format and DICOM connectivity used in newer systems. After a year of operation, we evaluated the efficacy of IHE connectivity by collecting questionnaires and performing interviews to compare system performance before and after the integration. The assessment showed that IHE connectivity provided greater accuracy for measurement data as well as for patient and examination information on the report. The conclusion was that IHE connectivity is effective in environments that mix new standards-based systems with existing legacy information systems.