Within a tradition of a dual regular and special education system in Japan, the Government is promoting education reform that encourages an inclusive approach to education. This research investigates whether teachers are being trained for successful inclusion in Japan by reviewing the perceptions of all preservice teachers in one university regarding their readiness for becoming inclusive practitioners. A move towards an inclusive approach to education in Japan is being promoted through collaboration and support between teachers trained in regular and special education. Thus, different perceptions of preservice teachers preparing to work either in elementary schools or in special schools are a particular focus of this research. Discussion considers the need for better teacher preparation due to the very low understandings of inclusion and Japanese pre-service teachers' perceived lack of skills, knowledge, experience, or training for an inclusive approach.
Pulmonary hypertension (PH) is characterized by elevated pulmonary arterial pressure (PAP). Although rightheart catheterization is the gold standard method for the diagnosis of PH by definition, various less-invasive imaging tests have been used for screening, detection of underlying diseases-causing PH, and monitoring of diseases. Among them, 4D flow MRI is an emerging and unique imaging test that allows for comprehensive visualization of blood flow in the right heart and proximal pulmonary arteries. The characteristic blood flow pattern observed in patients with PH is vortical flow formation in the main pulmonary artery. Recent studies have proposed the use of these findings to determine not only the presence of PH but also estimate the mean PAP. Other applications of 4D flow MRI for PH include measurement of wall shear stress, helicity, and 3D flow balance in the pulmonary arteries. It is worth noting that 4D flow has also the potential for longitudinal followups. In this review, the clinical definition of PH, summary of conventional imaging tests, characteristics of pulmonary arterial flow as shown by 4D flow MRI, and clinical application of 4D flow MRI in the management of patients with PH will be discussed.
Objective
Regional differences in cardiac magnetic resonance, which can reveal catecholamine-induced myocardial injury in patients with pheochromocytoma, have not yet been assessed using 3T magnetic resonance imaging. We evaluated these differences using myocardial T1-mapping and strain analysis.
Design and Methods
We retrospectively reviewed 16 patients newly diagnosed with catecholamine-producing tumors (CPT group) and 16 patients with essential hypertension (EH group), who underwent cardiac magnetic resonance imaging between May 2016 and March 2018. We acquired 3T magnetic resonance cine and native T1-mapping images and performed feature-tracking-based strain analysis in the former.
Results
Global cardiac function, morphology, global strain and peak strain rate were similar, but end-diastolic wall thickness differed between groups (CPT vs EH: 10.5 ± 1.7 vs 12.6 ± 2.8 mm; P < 0.05). Basal, but not apical, circumferential strain was significantly higher in the CPT than the EH group (19.4 ± 3.2 vs 16.8 ± 3.6 %; P < 0.05). Native T1 values were significantly higher in CPT than in EH patients, in both the basal septum (1307 ± 48 vs 1241 ± 45 ms; P < 0.01) and the apical septum (1377 ± 59 vs 1265 ± 58 ms; P < 0.01) mid-walls. In the CPT, but not in the EH group, native T1 values in the apical wall were significantly higher than those in the basal wall (P < 0.01).
Conclusion
3T magnetic resonance-based T1-mapping can sensitively detect subclinical catecholamine-induced myocardial injury; the influence of catecholamines may be greater in the apical than in the basal wall.
Magnetic resonance imaging (MRI) plays an important role in evaluation of the cardiovascular system. Two-dimensional phase-contrast MRI has been used to assess regional blood flow parameters such as flow velocity and volume and regurgitant fraction. Recently, fourdimensional (4D) flow MRI that acquires three-dimensional (3D) velocity and encodes volume coverage has been developed and applied to various clinical settings. 4D flow MRI allows retrospective flow measurement at any cross-section and 3D flow visualization through postprocessing. More advanced flow parameters based on fluid dynamics have been proposed and applied to 4D flow MRI to further understand flow mechanisms that might be related to the evolution and progression of cardiovascular diseases. The purpose of this review is to introduce the basics of 4D flow image acquisition and postprocessing, and its clinical application to selected cardiovascular diseases.
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