Intracoronary Cardiac Progenitor Cells in Single Ventricle Physiology: The PERSEUS (Cardiac Progenitor Cell Infusion to Treat Univentricular Heart Disease) Randomized Phase 2 Trial.

RATIONALE: Patients with single ventricle physiology are at high risk of mortality resulting from ventricular dysfunction. The preliminary results of the phase 1 trial showed that cardiosphere-derived cells (CDCs) may be effective against congenital heart failure. OBJECTIVE: To determine whether intracoronary delivery of autologous CDCs improves cardiac function in patients with single ventricle physiology. METHODS AND RESULTS: We conducted a phase 2 randomized controlled study to assign in a 1:1 ratio 41 patients who had single ventricle physiology undergoing stage 2 or 3 palliation to receive intracoronary infusion of CDCs 4 to 9 weeks after surgery or staged reconstruction alone (study A). The primary outcome measure was to assess improvement in cardiac function at 3-month follow-up. Four months after palliation, controls had an alternative option to receive late CDC infusion on request (study B). Secondary outcomes included ventricular function, heart failure status, somatic growth, and health-related quality of life after a 12-month observation. At 3 months, the absolute changes in ventricular function were significantly greater in the CDC-treated group than in the controls (+6.4% [SD, 5.5] versus +1.3% [SD, 3.7]; P=0.003). In study B, a late CDC infusion in 17 controls increased the ventricular function at 3 months compared with that at baseline (38.8% [SD, 7.7] versus 34.8% [SD, 7.4]; P<0.0001). At 1 year, overall CDC infusion was associated with improved ventricular function (41.4% [SD, 6.6] versus 35.0% [SD, 8.2]; P<0.0001) and volumes (P<0.001), somatic growth (P<0.0001) with increased trophic factors production, such as insulin-like growth factor-1 and hepatocyte growth factor, and quality of life, along with a reduced heart failure status (P<0.0001) and cardiac fibrosis (P=0.014) relative to baseline. CONCLUSIONS: Intracoronary infusion of CDCs after staged palliation favorably affected cardiac function by reverse remodeling in patients with single ventricle physiology. This impact may improve heart failure status, somatic growth, and quality of life in patients and reduce parenting stress for their families. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01829750.

Image Evaluation of Free-breathing Navigator Echo and Triggered Cardiac-gated Delayed Myocardial Enhancement Magnetic Resonance Imaging in Sedated Infants.

We validated a navigator-echo-triggered sequence that drives magnetization before cardiac-gated inversion recovery T1 turbo field echo acquisition, in the sedated free-breathing pediatric population. Cardiac magnetic resonance imaging was performed on sedated infants with single ventricle. We calculated the signal-to-noise ratios and contrast-to-noise ratios of 2 groups of images obtained using respiratory triggering with and without navigator echo. All images were then visually assessed by 2 observers. The signal-to-noise ratio and the contrast-to-noise ratio were significantly higher with than without navigator echo (p<0.01; p<0.05). The visual assessment scores were also consistently better with than without navigator echo (p<0.01). Free-breathing navigator echo was found to have the advantage of decreasing the motion artifact caused by respiration. Cardiacgated inversion recovery T1 turbo field echo sequence for free-breathing navigator-echo-triggered respiration allows for the acquisition, in sedated infants, of diagnostic images whose quality exceeds that of the non-navigator-echo-triggered alternative.

Intracoronary autologous cardiac progenitor cell transfer in patients with hypoplastic left heart syndrome: the TICAP prospective phase 1 controlled trial.

RATIONALE: Hypoplastic left heart syndrome (HLHS) remains a lethal congenital cardiac defect. Recent studies have suggested that intracoronary administration of autologous cardiosphere-derived cells (CDCs) may improve ventricular function. OBJECTIVE: The aim of this study was to test whether intracoronary delivery of CDCs is feasible and safe in patients with hypoplastic left heart syndrome. METHODS AND RESULTS: Between January 5, 2011, and January 16, 2012, 14 patients (1.8±1.5 years) were prospectively assigned to receive intracoronary infusion of autologous CDCs 33.4±8.1 days after staged procedures (n=7), followed by 7 controls with standard palliation alone. The primary end point was to assess the safety, and the secondary end point included the preliminary efficacy to verify the right ventricular ejection fraction improvements between baseline and 3 months. Manufacturing and intracoronary delivery of CDCs were feasible, and no serious adverse events were reported within the 18-month follow-up. Patients treated with CDCs showed right ventricular ejection fraction improvement from baseline to 3-month follow-up (46.9%±4.6% to 52.1%±2.4%; P=0.008). Compared with controls at 18 months, cardiac MRI analysis of CDC-treated patients showed a higher right ventricular ejection fraction (31.5%±6.8% versus 40.4%±7.6%; P=0.049), improved somatic growth (P=0.0005), reduced heart failure status (P=0.003), and lower incidence of coil occlusion for collaterals (P=0.007). CONCLUSIONS: Intracoronary infusion of autologous CDCs seems to be feasible and safe in children with hypoplastic left heart syndrome after staged surgery. Large phase 2 trials are warranted to examine the potential effects of cardiac function improvements and the long-term benefits of clinical outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01273857.

Thallium-201 Uptake of Giant Cell Tumor: One Step Toward the Differential Diagnosis to Atypically Presenting Osteosarcoma.

OBJECTIVE: The radiologic differential diagnosis of giant cell tumors (GCTs) is challenging because there is a risk of misdiagnosis of GCTs as malignant lesions such as atypically presenting osteosarcomas (OSs). This study aims to assess the feasibility of 201Tl scintigraphy for the differential diagnosis of GCT and atypical OS. MATERIALS AND METHODS: Thallium-201 scintigraphy scans obtained between January 2006 and October 2015 of patients with histologically proven GCT (23 patients [male-to-female ratio, 15:8]; median age, 33.0 years; age range, 20-61 years) and patients with atypically presenting OS (20 patients [male-to-female ratio, 11:9]; median age, 30.0 years; age range, 12-69 years) were retrospectively reviewed. Morphologic classification of osseous lesions was performed on radiographs and CT scans. The 201Tl scintigraphy-based tumor-to-background contrast (TBC) and washout rate (WR) were calculated on early phase and delayed phase scans. The laboratory parameters lactate dehydrogenase (LDH), C-reactive protein (CRP), and alkaline phosphatase were obtained. Statistical significance was estimated using the Mann-Whitney U test. Cutoff values were calculated for early phase TBC and delayed phase TBC. RESULTS: Twenty-two of 23 GCTs were detected on the initial radiographs, whereas only six of 20 atypical OSs were detected on the initial radiographs. The early phase TBC was increased in GCT (median, 2.59; range, 0.51-12.26) compared with atypical OS (median, 1.68; range, 0.90-6.45) (p = 0.07). The delayed phase TBC was increased in GCT (median, 1.65; range, 0.22-5.26) compared with atypical OS (median, 0.96; range, 0.39-3.76) (p = 0.02). The median WR was not significantly decreased in GCT. The cutoff value for the early phase TBC was 3.90, and the cutoff value for the delayed phase TBC was 1.64; these cutoff values for early and delayed phase TBC yielded a sensitivity of 80.0% and a specificity of 47.8% and 52.2% respectively. Serum LDH (mean: atypical OS vs GCT, 215.5 vs 170.5 U/L, respectively; p = 0.01), alkaline phosphatase (median: 355.0 vs 252.0 U/L; p = 0.03), and CRP (median: 0.21 vs 0.09 mg/dL; p = 0.04) values were significantly increased in atypical OS compared with GCT. CONCLUSION: The intense 201Tl uptake of GCT in combination with laboratory OS biomarkers facilitate the differential diagnosis of GCT and atypically presenting OS.

Coronary lesion characteristics with mismatch between fractional flow reserve derived from CT and invasive catheterization in clinical practice.

High diagnostic performance of noninvasive fractional flow reserve computed from CT (FFR-CT) was recently reported in prospective multicenter trials. The aims of this study were to evaluate the diagnostic accuracy of FFR-CT in clinical practice and to examine the lesion characteristics showing a mismatch between FFR-CT and invasive FFR. A total of 20 patients (29 vessels) with suspected coronary artery disease were included. All patients underwent invasive coronary angiography and invasive FFR according to coronary artery CT angiography (CCTA) findings. The same raw data used for CCTA were used to evaluate FFR-CT. Results from FFR-CT were compared with invasively measured FFR. A positive ischemia was defined as FFR <0.80. Analyses from three vessels in two patients were not evaluated because of severe calcification or motion artifacts. The diagnostic accuracy, sensitivity, and specificity of FFR-CT per-vessel basis were 81, 100, and 69 %, respectively. To find the reason for mismatch in positive ischemia, lesion characteristics determined with CCTA were compared between the matched group and the mismatched group. A significant difference in bifurcation lesions with positive remodeling was observed between the matched group and the mismatched group (p < 0.01). The high sensitivity of FFR-CT may provide an additional support to the use of CCTA, although particular attention should be paid when using FFR-CT in bifurcation lesions with positive remodeling.

Image Quality of Coronary Arteries on Non-electrocardiography-gated High-Pitch Dual-Source Computed Tomography in Children with Congenital Heart Disease.

This study aimed to evaluate image quality of coronary artery imaging on non-electrocardiography (ECG)-gated high-pitch dual-source computed tomography (DSCT) in children with congenital heart disease (CHD) and to assess factors affecting image quality. We retrospectively reviewed the records of 142 children with CHD who underwent non-ECG-gated high-pitch DSCT. The subjective image quality of the proximal coronary segments was graded using a five-point scale. A score <3 represented a non-diagnostic image. Age, body weight, and heart rate were compared between the two groups: patients with good diagnostic image quality in all four segments and patients with at least one segment with non-diagnostic image quality. Predictors of image quality were assessed by multivariate logistic regression, including age, body weight, and heart rate. Four-hundred-fifty-seven of the 568 segments (80.5%) had diagnostic image quality. Patients with non-diagnostic segments were significantly younger (21.6 ± 25.5 months), had lower body weight (7.82 ± 5.00 kg), and a faster heart rate (123 ± 23.7 beats/min) (each p < 0.05) than patients with diagnostic image quality in all four segments (30.6 ± 20.7 months, 10.3 ± 4.00 kg, and 113 ± 21.6 beats/min, respectively; each p < 0.05). The multivariate logistic regression revealed that body weight (odds ratio 1.228; p = 0.029) was a significant predictor of image quality. Non-ECG-gated high-pitch DSCT provided adequate image quality of the proximal coronary segments in children with CHD. Lower body weight was a factor that led to poorer image quality of the coronary arteries.

Evaluating Low-kV Dual-source CT Angiography by High-pitch Spiral Acquisition and Iterative Reconstruction in Pediatric Congenital Heart Disease Patients.

We retrospectively evaluated the qualities of pediatric cardiovascular dual-source computed tomography (DSCT) images reconstructed by sinogram-affirmed iterative reconstruction (SAFIRE) and filtered back projection (FBP). We analyzed the cases of 287 congenital heart disease (CHD) patients < 5 years old, referred to our department in August 2013-March 2015. We divided them into two groups according to tube voltage (70 kVp, n=147; 80 kVp, n=140). All images were acquired by a CARE kV system and reconstructed by FBP and SAFIRE. The attenuation, noise, and signal-to-noise ratio (SNR) at each region of the heart and great vessels were measured. The volume CT dose index and dose-length product values were recorded. Compared to FBP, reconstruction by SAFIRE showed that the attenuation volume was significantly lower by 0.4% except for the ascending aorta (p<0.05), the noise value was lower by about 20% (p<0.05), and the SNR was higher by approx. 25% (p<0.05). The radiation dose in the 70 kVp group was significantly lower than that in the 80 kVp group. No significant differences in SNR were observed between the patient groups. DSCT image acquisition with SAFIRE using the CARE kV system results in low image noise and radiation dose in pediatric patients with CHD.

Evaluation of Urinary Stone Composition and Differentiation between Urinary Stones and Phleboliths Using Single-source Dual-energy Computed Tomography.

The aim of this study was to investigate the utility of single-source dual-energy computed tomography (SS-DECT) composition analysis in characterizing different types of urinary stones and differentiating them from phleboliths. This study included 29 patients with urinary stones who were scheduled for surgery. All patients were scanned, first using single-energy computed tomography acquisition and then DECT acquisition on SS-DECT. Dual-energy data were archived to a Gemstone spectral imaging (GSI) viewer (GE Healthcare, Milwaukee, WI, USA). Hounsfield units (HU) and effective atomic numbers (Zeff) were estimated using the GSI viewer. The results of dual-energy analysis were compared with the biochemical constitution of the stones. The chemical analysis determined that the stones included 32 calcium-based, 6 cystine and 1 struvite stone. Both HU and Zeff values were helpful in differentiating calcium-based stones from cystine and struvite stones and phleboliths. The Zeff values of phleboliths were significantly higher than those for struvite and cystine stones, whereas it was difficult to distinguish phleboliths from struvite and cystine stones using the HU values. Composition analysis using SS-DECT is helpful for distinguishing urinary stone types and discriminating phleboliths from urinary stones. Zeff values may be more useful than HU values for differentiating urinary stones from phleboliths.

Diagnostic Value of Dual-time-point F-18 FDG PET/CT and Chest CT for the Prediction of Thymic Epithelial Neoplasms.

We retrospectively assessed the dual-time-point (DTP) F-18 FDG PET/CT findings of thymic epithelial neoplasms (TENs) and investigated the diagnostic capacity of PET/CT compared to that of CT for predicting carcinoma. We calculated the ratio of the standardized uptake value of the tumor and that of the aortic arch (T/M ratio) for both the 90-min early scan and the 2-h delayed scan in 56 TEN patients. We used a multivariate logistic regression (MLR) analysis to estimate the CT features of carcinoma. We compared the diagnostic capacities of PET/CT and chest CT using receiver operating characteristic (ROC) analyses. The ROC curve revealed that the appropriate cut-off T/M ratio value for the highest accuracy was 2.39 with 75.0% accuracy. The area under the curve (AUC) was 0.855. The statistical analyses for DTP scans of 35 TEN patients demonstrated 74.3% accuracy and 0.838 AUC for the early scan versus 82.9% and 0.825 for the delayed scan. The MLR analysis indicated that mediastinal fat infiltration was a predictor of carcinoma. The ROC curve obtained for the model yielded an AUC of 0.853. Delayed scanning could improve the diagnostic capacity for carcinoma. The T/M ratio and mediastinal fat infiltration are predictive of carcinoma with moderate diagnostic accuracy.

Ankle muscle coactivation and its relationship with ankle joint kinematics and kinetics during gait in hemiplegic patients after stroke.

INTRODUCTION: Increased ankle muscle coactivation during gait is a compensation strategy for enhancing postural stability in patients after stroke. However, no previous studies have demonstrated that increased ankle muscle coactivation influenced ankle joint movements during gait in patients after stroke. PURPOSE: To investigate the relationship between ankle muscle coactivation and ankle joint movements in hemiplegic patients after stroke. METHODS: Seventeen patients after stroke participated. The coactivation index (CoI) at the ankle joint was calculated separately for the first and second double support (DS1 and DS2, respectively) and single support (SS) phases on the paretic and non-paretic sides during gait using surface electromyography. Simultaneously, three-dimensional motion analysis was performed to measure the peak values of the ankle joint angle, moment, and power in the sagittal plane. Ground reaction forces (GRFs) of the anterior and posterior components and centers of pressure (COPs) trajectory ranges and velocities were also measured. RESULTS: The CoI during the SS phase on the paretic side was negatively related to ankle dorsiflexion angle, ankle plantarflexion moment, ankle joint power generation, and COP velocity on the paretic side. Furthermore, the CoI during the DS2 phase on both sides was negatively related to anterior GRF amplitude on each side. CONCLUSION: Increased ankle muscle coactivation is related to decreased ankle joint movement during the SS phase on the paretic side to enhance joint stiffness and compensate for stance limb instability, which may be useful for patients who have paretic instability during the stance phase after stroke.

Association between coronary artery calcification and left ventricular diastolic dysfunction in elderly people.

Coronary artery calcification (CAC) is associated with the incidence of congestive heart failure. We evaluated the association between CAC and left ventricular diastolic dysfunction (LVDD) in elderly patients without coronary artery disease. Coronary computed tomography was performed in 1,021 consecutive patients >55 years of age who were suspected of having coronary artery disease. A total of 530 patients (age, 70 ± 8 years; 56 % men) with a LV ejection fraction >50 % and without obstructive coronary artery disease and a history of coronary artery disease were included in the analysis. LVDD was defined according to a standard algorithm by echocardiography (septal e' <8, lateral e' <10, and left atrial volume index ≥34 mL/m(2)). A total of 224 of 530 patients had LVDD. CAC scores in patients with LVDD were higher than those in patients without LVDD (p < 0.01). The prevalence of LVDD in patients with CAC scores ≥400 was greater than that in patients with CAC scores of 0-9 (58 vs. 34 %, p < 0.01). After adjustment for confounding factors, the CAC score was associated with LVDD, with an odds ratio of 1.96 (95 % confidence interval: 1.11-3.43, p = 0.02) for a CAC score ≥400 compared with a CAC score of 0-9. A CAC score ≥400 was associated with LVDD in elderly patients without CAD in this population. Further prospective studies are needed to evaluate the clinical relevance of CAC as a risk of heart failure with preserved ejection fraction.

Measurement of epicardial fat thickness by transthoracic echocardiography for predicting high-risk coronary artery plaques.

Epicardial adipose tissue (EAT) volume is reported to be associated with coronary plaques. We evaluated whether non-invasive measurement of EAT thickness by echocardiography can predict high-risk coronary plaque characteristics determined independently by coronary computed tomography (CT) angiography. We enrolled 406 patients (mean age 63 years, 57 % male) referred for 64-slice CT. EAT was measured on the right ventricle free wall from a parasternal long-axis view at the end of systole. High-risk coronary plaques were defined as low-density plaques (<30 Hounsfield units) with positive remodeling (remodeling index >1.05). Patients were divided into thin or thick EAT groups using a cutoff value derived from receiver operator characteristic curve analysis for discriminating high-risk plaques. The receiver operator characteristic cutoff value was 5.8 mm with a sensitivity of 83 % and specificity of 64 % (area under the curve 0.77, 95 % confidence interval 0.70-0.83, p < 0.01). Compared with the thin EAT group, the thick EAT group had a high prevalence of low-density plaques (4 vs. 24 %, p < 0.01), positive remodeling (39 vs. 60 %, p < 0.01), and high-risk plaques (3 vs. 17 %, p < 0.01). Multiple logistic analysis revealed that thick EAT was a significant predictor of high-risk plaques (odds ratio 7.98, 95 % confidence interval 2.77-22.98, p < 0.01) after adjustment for covariates, including conventional risk factors, visceral adipose tissue area, and medications. The measurement of EAT thickness by echocardiography may provide a non-invasive option for predicting high-risk coronary plaques.

Criteria for radiologic diagnosis of hypochondroplasia in neonates.

BACKGROUND: A radiologic diagnosis of hypochondroplasia is hampered by the absence of age-dependent radiologic criteria, particularly in the neonatal period. OBJECTIVE: To establish radiologic criteria and scoring system for identifying neonates with fibroblast growth factor receptor 3 (FGFR3)-associated hypochondroplasia. MATERIALS AND METHODS: This retrospective study included 7 hypochondroplastic neonates and 30 controls. All subjects underwent radiologic examination within 28 days after birth. We evaluated parameters reflecting the presence of (1) short ilia, (2) squared ilia, (3) short greater sciatic notch, (4) horizontal acetabula, (5) short femora, (6) broad femora, (7) metaphyseal flaring, (8) lumbosacral interpedicular distance narrowing and (9) ovoid radiolucency of the proximal femora. RESULTS: Only parameters 1, 3, 4, 5 and 6 were statistically different between the two groups. Parameters 3, 5 and 6 did not overlap between the groups, while parameters 1 and 4 did. Based on these results, we propose a scoring system for hypochondroplasia. Two major criteria (parameters 3 and 6) were assigned scores of 2, whereas 4 minor criteria (parameters 1, 4, 5 and 9) were assigned scores of 1. All neonates with hypochondroplasia in our material scored ≥6. CONCLUSION: Our set of diagnostic radiologic criteria might be useful for early identification of hypochondroplastic neonates.

Exploratory analysis of textual data from the Mother and Child Handbook using the text-mining method: Relationships with maternal traits and post-partum depression.

AIM: The aim of the present study was to examine the possibility of screening apprehensive pregnant women and mothers at risk for post-partum depression from an analysis of the textual data in the Mother and Child Handbook by using the text-mining method. METHODS: Uncomplicated pregnant women (n = 58) were divided into two groups according to State-Trait Anxiety Inventory grade (high trait [group I, n = 21] and low trait [group II, n = 37]) or Edinburgh Postnatal Depression Scale score (high score [group III, n = 15] and low score [group IV, n = 43]). An exploratory analysis of the textual data from the Maternal and Child Handbook was conducted using the text-mining method with the Word Miner software program. A comparison of the 'structure elements' was made between the two groups. RESULTS: The number of structure elements extracted by separated words from text data was 20 004 and the number of structure elements with a threshold of 2 or more as an initial value was 1168. Fifteen key words related to maternal anxiety, and six key words related to post-partum depression were extracted. CONCLUSION: The text-mining method is useful for the exploratory analysis of textual data obtained from pregnant woman, and this screening method has been suggested to be useful for apprehensive pregnant women and mothers at risk for post-partum depression.

Image Quality of Coronary Computed Tomography Angiography with 320-Row Area Detector Computed Tomography in Children with Congenital Heart Disease.

The objective of this study was to assess factors affecting image quality of 320-row computed tomography angiography (CTA) of coronary arteries in children with congenital heart disease (CHD). We retrospectively reviewed 28 children up to 3 years of age with CHD who underwent prospective electrocardiography (ECG)-gated 320-row CTA with iterative reconstruction. We assessed image quality of proximal coronary artery segments using a five-point scale. Age, body weight, average heart rate, and heart rate variability were recorded and compared between two groups: patients with good diagnostic image quality in all four coronary artery segments and patients with at least one coronary artery segment with nondiagnostic image quality. Altogether, 96 of 112 segments (85.7 %) had diagnostic-quality images. Patients with nondiagnostic segments were significantly younger (10.0 ± 11.6 months) and had lower body weight (5.9 ± 2.9 kg) (each p < 0.05) than patients with diagnostic image quality of all four segments (20.6 ± 13.8 months and 8.4 ± 2.5 kg, respectively; each p < 0.05). Differences in heart rate and heart rate variability between the two imaging groups were not significant. Receiver operating characteristic analyses for predicting patients with nondiagnostic image quality revealed an optimal body weight cutoff of ≤5.6 kg and an optimal age cutoff of ≤12.5 months. Prospective ECG-gated 320-row CTA with iterative reconstruction provided feasible image quality of coronary arteries in children with CHD. Younger age and lower body weight were factors that led to poorer image quality of coronary arteries.

A Case of Focal Bone Marrow Reconversion Mimicking Bone Metastasis: The Value of 111Indium Chloride.

We present a case of a 66-year-old man with esophageal carcinoma. 18Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for evaluating distant metastasis and staging revealed 18F-FDG uptake in the third lumbar vertebra and other vertebrae. Magnetic resonance imaging could not differentiate bone metastases from benign bone lesions. We considered the possibility of bone marrow reconversion. 111Indium chloride (111In-Cl3) scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed erythroid bone marrow components in the bone lesions. The diagnosis of bone marrow reconversion was pathologically confirmed by a bone biopsy of the third lumbar vertebra. The patient underwent esophagectomy and has remained disease-free in the 2 years since. To the best of our knowledge, this is the first report to describe the usefulness of 111In-Cl3 with SPECT/CT for the diagnosis of bone marrow reconversion.

Differential association of visceral adipose tissue with coronary plaque characteristics in patients with and without diabetes mellitus.

BACKGROUND: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood. METHODS: We retrospectively evaluated 456 patients (60% male, age 64 ± 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification). RESULTS: Patients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08-9.31, p = 0.04), but not in patients with DM. CONCLUSIONS: The VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.

Subjective depressive mood and regional cerebral blood flow in mild Alzheimer's disease.

BACKGROUND: Depressive symptoms are common in patients with Alzheimer's disease (AD) and increase the caregiver burden, although the etiology and pathologic mechanism of depressive symptoms in AD patients remain unclear. In this study, we tried to clarify the cerebral blood flow (CBF) correlates of subjective depressive symptoms in AD. METHODS: Seventy-six consecutive patients with AD were recruited from outpatient units of the Memory Clinic of Okayama University Hospital. Subjective depressive symptoms were evaluated using the short version of the Geriatric Depression Scale (GDS). All patients underwent brain SPECT with 99mTc-ethylcysteinate dimer, and the SPECT images were analyzed by the Statistical Parametric Mapping 8 program. RESULTS: No significant differences between groups with high and low GDS scores were found with respect to age, sex, years of education, and revised Addenbrooke's Cognitive Examination scores. Compared to patients with low scores on GDS, patients with high scores showed significant hypoperfusion in the left inferior frontal region. CONCLUSIONS: The left inferior frontal region may be significantly involved in the pathogenesis of subjective depressive symptoms in AD. Subjective and objective depressive symptoms may have somewhat different neural substrates in AD.

Safety and efficacy of a bolus injection of landiolol hydrochloride as a premedication for multidetector-row computed tomography coronary angiography.

BACKGROUND: We evaluated the safety and efficacy of a bolus injection of landiolol hydrochloride, an ultrashort-acting ß1-selective antagonist, as an additional treatment after premedication with an oral ß-blocker to reduce heart rate prior to multidetector-row computed tomography (MDCT) coronary angiography (CAG). METHODS AND RESULTS: A total of 458 patients who underwent MDCT CAG were retrospectively enrolled. Image quality and hemodynamic parameters were compared in patients before and after approval of landiolol hydrochloride. If heart rate reduction was insufficient after premedication with an oral ß-blocker, a bolus injection of landiolol hydrochloride (n=66) or other drugs (n=30) was used. The percentage of evaluable images per segment in patients after approval of landiolol (99.3%) was greater than that in patients before approval of landiolol (97.4%, P<0.01). Heart rates before scanning in patients receiving landiolol hydrochloride were similar to those receiving other drugs. Heart rate was significantly reduced approximately 5 min after injection of landiolol hydrochloride and increased shortly. No decrease in systolic blood pressure or other adverse effects was observed. CONCLUSIONS: Bolus injection of landiolol hydrochloride sufficiently reduced heart rate without significantly reducing systolic blood pressure and produced a high percentage of evaluable images, suggesting that bolus injection of landiolol hydrochloride as an additional pretreatment is feasible in MDCT CAG.

Factors influencing breast density in Japanese women aged 40-49 in breast cancer screening mammography.

A relatively large number of women in their 40s with high-density breasts, in which it can be difficult to detect lesions, are encountered in mammography cancer screenings in Japan. Here, we retrospectively investigated factors related to breast density. Two hundred women (40-49 years old) were examined at the screening center in our hospital. Multivariate analysis showed that factors such as small abdominal circumference, high HDL cholesterol, and no history of childbirth were related to high breast density in women in their 40s undergoing mammography. Other non-mammographic screening methods should be considered in women with abdominal circumferences < 76cm, HDL-C ≥ 53mg/dl, and no history of childbirth, as there is a strong possibility of these women having high-density breasts that can make lesion detection difficult.