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Objective To study the value of multitime point salivary pepsin testing (MTPSPT) for the diagnosis of laryngopharyngeal reflux (LPR). Study Design Prospective noncontrolled. Methods For patients who met the enrollment criteria, the reflux symptom index (RSI) and reflux finding score (RFS) were calculated and salivary pepsin testing was performed. The pepsin test was performed every hour from 7:00 a.m. to 6:00 p.m. by collecting fresh saliva samples. A single positive test result was needed for the diagnosis of LPR. The consistency in the diagnosis of LPR between the two methods was compared with the weighted Cohen's kappa statistic. Results A total of 204 patients were included. The kappa value between the two methods was 0.566 (p = .00). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MTPSPT were 76.43%, 85.94%, 92.24%, and 62.5%, respectively. We also compared a single pepsin measure at 7 a.m. with the screening results based on the RSI and RFS, and found a much lower kappa agreement value (0.223, p = .00). The sensitivity, specificity, PPV, NPV, and false‐negative rate of pepsin testing at 7 a.m. (fasting) were 37.86%, 92.18%, 91.38%, 40.41%, and 58.57%, respectively. Conclusion The use of the result of a single salivary pepsin test in the morning yields a relatively higher rate of missed diagnosis of LPR, and multitime point testing through a day increased the accuracy and sensitivity of detection of LPR twofold compared to a single morning fasting sample. Level of Evidence 3

In this paper, a novel Co3O4 micro-bundles structure (Co3O4 MBs) was obtained at 120 °C after a hydrothermal reaction for 24 h and followed by an annealing treatment at 300 °C in air. The unique Co3O4 MBs are constructed by many adjacent flakes with 0.4 μm in thickness, and exhibit a large surface area of 81.2 m2 g−1 and a mean pore diameter of 6.14 nm, which may facilitate a sufficient contact with electrolyte and then shorten the diffusion pathway of ions. A remarkable electrochemical behavior including specific capacity of 282.3 C g−1 at 1 A g−1 and 205.9 C g−1 at 10 A g−1, and an excellent cycling performance with 74.6% capacity retention after 4000 charge-discharge process at 5 A g−1 are achieved when the test of Co3O4 MBs-modified electrode is performed using three-electrode configuration. Additionally, a hybrid supercapacitor (HSC) was fabricated with the obtained Co3O4 MBs as positive electrode and commercial activated carbon (AC) as negative electrode. The HSC exhibits a specific capacity of 144.1 C g−1 at 1 A g−1 and 126.4% capacity retention after 5000 cycles at 5 A g−1. An energy density of 38.5 W h kg−1 can be obtained at a power density of 962.0 W kg−1, and 29.5 W h kg−1 is still retained at 8532.5 W kg−1. The simple synthetic strategy can be applicable to the synthesis of other transition metal oxides with superior electrochemical performance.

Bone morphogenetic protein 7 (BMP7), a member of the transforming growth factor-β (TGF-β) family, plays pivotal roles in energy expenditure. However, whether and how BMP7 regulates hepatic insulin sensitivity is still poorly understood. Here, we show that hepatic BMP7 expression is reduced in high-fat diet (HFD)-induced diabetic mice and palmitate (PA)-induced insulin-resistant HepG2 and AML12 cells. BMP7 improves insulin signaling pathway in insulin resistant hepatocytes. On the contrary, knockdown of BMP7 further impairs insulin signal transduction in PA-treated cells. Increased expression of BMP7 by adenovirus expressing BMP7 improves hyperglycemia, insulin sensitivity and insulin signal transduction. Furthermore, BMP7 inhibits mitogen-activated protein kinases (MAPKs) in both the liver of obese mice and PA-treated cells. In addition, inhibition of MAPKs recapitulates the effects of BMP7 on insulin signal transduction in cultured hepatocytes treated with PA. Activation of p38 MAPK abolishes the BMP7-mediated upregulation of insulin signal transduction both in vitro and in vivo. Together, our results show that hepatic BMP7 has a novel function in regulating insulin sensitivity through inhibition of MAPKs, thus providing new insights into treating insulin resistance-related disorders such as type 2 diabetes.

Although temperature is a main external effect on rock decay, the relationship between a rock’s decay rate and temperature still remains unclear and there is limited information about the rate of rock decay under varied temperatures during dry–wet cycle conditions in southwest China. Therefore, the aim of the present paper was to explore the rate of mudstone decay through an experiment, in which a model was proposed to calculate their decay rates under varied temperatures conditions. A set of customized test device, including a model test container, a thermostat-controlled heating plate, and a water supply and drainage device, was applied in the experiment. Three dry–wet cycles were conducted on five samples at 60, 90, 105, 120 and 180 °C, respectively. The crack width, vertical displacement and wetted area were measured to analyse the temperature-induced decay mechanism during dry–wet cycle processes. The results showed that tiny cracks appeared on the surface of samples after heating and that the vertical displacement increased in the upward direction due to swelling of the mudstone after water exposure. The crack width extended with increasing water exposure, but it decreased after the surface of samples was gradually wetted after several hours of water exposure. The continually increasing wetted area and progressively fast wetting speed were the outward manifestation of the increasing number of internal cracks. Temperature-induced stress could promote the generation of cracks and decay rates of the tested rocks raised with higher temperatures. Quantitative analysis revealed that the rock decay rate is significantly related to temperature in the form of a S-Curve. The sample barely decayed at 60 °C, but the decay rate was close to 90% at 180 °C. The higher the temperature was, the faster the wetting speed was and the more cracks generated, and ultimately rocks decayed as a result of crack extension.

Rock masses in southwest China are dominated by alternating layers of sandstone and mudstone. When exposed to natural conditions, mudstone is vulnerable to disintegration, causing the overlying sandstone to be extremely likely to collapse under the action of a load or other conditions. An effective and innovative experimental method to characterize weathering processes would contribute to collapse prevention. In this study, a customized test unit, including a model test container, a lever-loading device and a thermostat-controlled heating plate, was applied to explore the mechanism of crack development in mudstone over multiple dry-wet cycles. The crack width, vertical displacement and wetted area were measured to analyse the slaking mechanism acting during these cycles. The results show that tiny cracks appeared on the surface of the sample after heating and that the vertical displacement increased in the upward direction because of swelling of mudstone. The crack width expanded with increasing water exposure, but after the water infiltrated the surface of the sample, the crack width decreased. The external surface of the sample was gradually infiltrated in the second dry-wet cycle, and the infiltration area increased continually. The infiltrating speed grew progressively faster with each cycle, and the number and size of internal cracks monotonically increased. The sample fractured as a result of crack extension. These results have theoretical significance regarding the ground collapse of alternating layers of sandstone and mudstone.

Objectives:To investigate the impact of deep learning (DL) on radiologists’ detection accuracy and reading efficiency of rib fractures on CT.Methods:Blunt chest trauma patients (n = 198) undergoing thin-slice CT were enrolled. Images were read by two radiologists (R1, R2) in three sessions: S1, unassisted reading; S2, assisted by DL as the concurrent reader; S3, DL as the second reader. The fractures detected by the readers and total reading time were documented. The reference standard for rib fractures was established by an expert panel. The sensitivity and false-positives per scan were calculated and compared among S1, S2, and S3.Results:The reference standard identified 865 fractures on 713 ribs (102 patients) The sensitivity of S1, S2, and S3 was 82.8, 88.9, and 88.7% for R1, and 83.9, 88.7, and 88.8% for R2, respectively. The sensitivity of S2 and S3 was significantly higher compared to S1 for both readers (all p < 0.05). The sensitivity between S2 and S3 did not differ significantly (both p > 0.9). The false-positive per scan had no difference between sessions for R1 (p = 0.24) but was lower for S2 and S3 than S1 for R2 (both p < 0.05). Reading time decreased by 36% (R1) and 34% (R2) in S2 compared to S1.Conclusions:Using DL as a concurrent reader can improve the detection accuracy and reading efficiency for rib fracture.Advances in knowledge:DL can be integrated into the radiology workflow to improve the accuracy and reading efficiency of CT rib fracture detection.

To investigate the image quality and the minimum required radiation dose for automatic tube potential selection (ATPS) in dual-source computed tomography (DSCT) coronary computed tomography angiography (CCTA). Three hundred twenty-five consecutive patients (153 men and 172 women) undergoing CCTA were assigned to either the ATPS group (n = 172) or the control group (n = 153); the control group underwent imaging at a constant current of 120 kV. All patients were scanned in either prospectively ECG-triggered high-pitch helical mode or sequential mode. The subjective image quality score, attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), volume CT dose index (CTDIvol), and effective dose (ED) were compared between the two groups with the Student t test or Mann–Whitney U test. The subjective image quality score was not significantly different between the two groups. Imaging noise and attenuation were both significantly higher in the ATPS group than in the control group (imaging noise: 25.6 ± 7.6 versus 15.8 ± 4.0 HU, P < 0.001; attenuation: 559.6 ± 142.0 versus 412.5 ± 64.3 HU, P < 0.001). SNR and CNR were significantly lower in the ATPS group than in the control group (SNR: 23.21 ± 7.40 versus 27.71 ± 8.25, P < 0.001; CNR: 27.81 ± 8.44 versus 33.94 ± 9.69, P < 0.001). ED was significantly lower in the ATPS group than in the control group (ED: 1.25 ± 1.24 versus 2.19 ± 1.77 mSv, P < 0.001). For both groups, ED was significantly lower in the high-pitch mode than in the sequential mode. The use of ATPS for CCTA significantly reduced the radiation dose while maintaining image quality.

The contrast medium (CM) induced nephropathy required new CT imaging protocol. This study evaluated the feasibility of low contrast medium (CM) volume and injection flow using aortic dual-energy CT (DECT) angiography with non-linear blending technique. Sixty patients were randomly assigned to two groups: control group (n=30), single-energy CT 70 ml CM at injection rate of 5 ml/s; study group (n=30), DECT mode, 0.5 ml per kg of patient weight CM at injection rate=(weight × 0.5 ml/kg)/(4+scan time). Non-linear blending technique was used for dual-energy images. Mean attention, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of aorta were compared. The level of visible renal artery branches was scored. There was no significant difference between the two groups in the mean aortic attention, SNR and CNR (all P > 0.05). Significant difference was showed in CM injection rate (p < 0.001) and volume (P < 0.001). The renal artery score had no statistically significant difference (P=0.771). Compared conventional scan and CM injection protocol, DECT with non-linear blending technique maintained the image quality of aortic CT angiography with reduced CM volume and flow rate, which could reduce the risks associated with CM injection.

PURPOSE To investigate the diagnostic accuracy of coronary computed tomographic (CT) angiography (CCTA) using filtered back projection (FBP) and sinogram-affirmed iterative reconstruction (SAFIRE) of different strength factors with invasive coronary angiography as the reference standard. MATERIALS AND METHODS Fifty consecutive patients (32 men and 18 women) prospectively underwent electrocardiogram-triggered CCTA on a dual-source CT system. The acquisition window was set depending on the heart rate (HR): HR of less than 60 beats per minute (bpm) at the 70% RR interval, 61 to 80 bpm at 30% to 80% RR interval, and greater than 80 bpm at 30% to 50% RR interval; 100 kV and 359 to 377 mA s for patients with a body mass index of less than 24 kg/m, and 410 to 438 mA s at 120 kV for patients with a body mass index of 24 kg/m or greater. Image data were reconstructed using both FBP and SAFIRE. Sinogram-affirmed iterative reconstruction series were reconstructed using 3 different strength factors. Two blinded observers independently assessed the image quality and image impression of each coronary segment using a 4-point scale (1, non-diagnostic; and 4, excellent). Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured. Filtered back projection and all SAFIRE series were independently evaluated for coronary artery stenosis (>50%), and their diagnostic accuracy was compared with invasive coronary angiography. RESULTS Statistically significant increases in SNR and CNR were obtained when higher strength factors were used. The highest SNR and CNR were found with the highest SAFIRE strength factor of 5; however, this strength also resulted in a more unfamiliar, "plasticlike" image appearance. Imaging quality scores of FBP and different SAFIRE strengths were 3.37 ± 0.49, 3.41 ± 0.47, 3.52 ± 0.30, and 3.48 ± 0.35, respectively (P < 0.001). The diagnostic accuracies were 92.91%, 93.76%, 95.28%, and 94.94% on per-segment level, respectively (P = 0.993). A tendency toward higher diagnostic performance was observed with SAFIRE strength factor 3 on per-segment analysis, albeit without reaching statistical significance. The effective radiation dose equivalent was 5.7 ± 1.6 mSv. CONCLUSION Sinogram-affirmed iterative reconstruction provides significant improvements in image noise, SNR, and CNR compared with FBP, which are progressive with increasing SAFIRE strength factors. Sinogram-affirmed iterative reconstruction strength factor 3 or 5 is recommended for use with CCTA.

Objectives This study sought to determine whether a 50%-reduced radiation dose protocol using iterative reconstruction (IR) preserves image quality and diagnostic accuracy at coronary computed tomography angiography (CTA) as compared with a routine dose protocol using traditional filtered back projection (FBP). Background IR techniques show promise to decrease radiation requirements at coronary CTA. No study has performed a direct head-to-head, intraindividual comparison of IR algorithms with FBP vis-a-vis diagnostic accuracy and radiation dose at coronary CTA. Methods Sixty consecutive subjects (45 men, 53.3 ± 9.4 years of age) prospectively underwent coronary catheter angiography (CCA) and 2 coronary CTA scans. One coronary CTA acquisition used routine radiation dose settings and was reconstructed with FBP. For another scan, the tube current–time product was reduced by 50%, and data were reconstructed with IR. Studies were blindly and randomly interpreted. Image quality, radiation dose, and diagnostic accuracy were compared using CCA as the reference standard. Results Sensitivity and specificity for diagnosing ≥50% coronary artery stenosis on a per-segment level were 88.5% and 92.1% with FBP and 84.2% and 93.4% with IR, respectively. On a per-patient level, sensitivity and specificity were 100% and 93.1% with FBP and 96.8% and 89.7% with IR, respectively (all p > 0.05). With FBP versus IR, the area under the receiver-operating characteristic curve was 0.903 (95% confidence interval [CI]: 0.881 to 0.922) and 0.888 (95% CI: 0.864 to 0.909) on a per-segment level, and 0.966 (95% CI: 0.883 to 0.996) and 0.932 (95% CI: 0.836 to 0.981) on a per-patient level, respectively (p = 0.290 and 0.330). Compared with FBP, the iterative series showed no significant (p > 0.05) differences in image quality analyses. Median dose–length product was 52% lower for the IR protocol compared with the FBP protocol (109.00 [interquartile range: 82.00 to 172.50] mGy·cm vs. 52.00 [interquartile range: 39.00 to 84.00] mGy·cm, p Conclusions Compared with a routine radiation dose FBP protocol, 50% reduced dose acquisition using IR preserves image quality and diagnostic accuracy at coronary CTA.

Aim To investigate image quality and potential for radiation dose reduction using sinogram-affirmed iterative reconstruction (SAFIRE) at computed tomography (CT) coronary angiography (CTCA) compared with filtered back-projection (FBP) reconstruction. Materials and methods A water phantom and 49 consecutive patients were scanned using a retrospectively electrocardiography (ECG)-gated CTCA protocol on a dual-source CT system. Image reconstructions were performed with both conventional FBP and SAFIRE. The SAFIRE series were reconstructed image data from only one tube, simulating a 50% radiation dose reduction. Two blinded observers independently assessed the image quality of each coronary segment using a four-point scale and measured image noise (the standard deviation of Hounsfield values, SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Radiation dose estimates were calculated. Results In the water phantom, image noise decreased at the same ratio as the tube current increased for both reconstruction algorithms. Despite an estimated radiation dose reduction from 7.9 ± 2.8 to 4 ± 1.4 mSv, there was no significant difference in the SD and SNR within the aortic root and left ventricular chamber between the two reconstruction methods. There was also no significant difference in the image quality between the FBP and SAFIRE series. Conclusion Compared with traditional FBP, there is potential for substantial radiation dose reduction at CTCA with use of SAFIRE, while maintaining similar diagnostic image quality.

To individually optimize contrast medium protocol for high-pitch prospective ECG-triggering coronary CT angiography using body weight. Ninety patients undergoing high-pitch coronary CT angiography were randomly assigned to 3 contrast medium injection protocols with bolus tracking technique: Group A, 0.7 ml CM per kg patient weight (ml/kg); Group B, 0.6 ml/kg; Group C, 0.5 ml/kg. Each group had 30 patients. The CT values of superior vena cava (SVC), pulmonary artery (PA), ascending aorta (AA), left atrium (LA), left ventricle (LV), left main artery (LM) and proximal segment of right coronary artery (RCA) were measured. The image quality of coronary artery was evaluated on per-segment basis using a 4-point scale (1-excellent, 4-non-diagnosis). The CT value was not significantly different on AA (p = 0.735), LM (p = 0.764), and proximal segment of RCA (p = 0.991). The CT value was significantly different on SVC, PA, LA and LV (all p < 0.05). The mean image quality score was 1.6 ± 0.1, 1.6 ± 0.1 and 1.6 ± 0.1 (p = 0.217). The volume of CM was 47 ± 8, 44 ± 8 and 36 ± 6 ml for 3 groups (p < 0.001). The effective radiation dose was 0.88 ± 0.04, 0.87 ± 0.06, and 0.85 ± 0.07 mSv for 3 groups. Contrast medium could be reduced to 0.5 ml/kg for high-pitch coronary CT angiography without compromising diagnostic image quality, which associated ~50 % reduction of total contrast volume compared with standard contrast protocol with test bolus technique.

Purpose To investigate the image quality and radiation dose of low radiation dose CT coronary angiography (CTCA) using sinogram affirmed iterative reconstruction (SAFIRE) compared with standard dose CTCA using filtered back-projection (FBP) in obese patients. Materials and methods Seventy-eight consecutive obese patients were randomized into two groups and scanned using a prospectively ECG-triggered step-and-shot (SAS) CTCA protocol on a dual-source CT scanner. Thirty-nine patients (protocol A) were examined using a routine radiation dose protocol at 120 kV and images were reconstructed with FBP (protocol A). Thirty-nine patients (protocol B) were examined using a low dose protocol at 100 kV and images were reconstructed with SAFIRE. Two blinded observers independently assessed the image quality of each coronary segment using a 4-point scale (1 = non-diagnostic, 4 = excellent) and measured the objective parameters image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Radiation dose was calculated. Results The coronary artery image quality scores, image noise, SNR and CNR were not significantly different between protocols A and B (all p > 0.05), with image quality scores of 3.51 ± 0.70 versus 3.55 ± 0.47, respectively. The effective radiation dose was significantly lower in protocol B (4.41 ± 0.83 mSv) than that in protocol A (8.83 ± 1.74 mSv, p Conclusion Compared with standard dose CTCA using FBP, low dose CTCA using SAFIRE can maintain diagnostic image quality with 50% reduction of radiation dose.

Aim To investigate the accuracy of high-pitch prospectively electrocardiogram (ECG)-triggering low-dose, dual-source computed tomography (CT) coronary angiography for assessing coronary artery stenosis compared with conventional coronary angiography. Materials and methods One hundred and three patients undergoing high-pitch CT coronary angiography (CTCA) and conventional coronary angiography (CCA) within 30 days were enrolled. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of high-pitch CTCA for detecting >50 and >70% stenosis were evaluated using CCA as the reference standard on a per-segment, per-vessel, and per-patient basis. Two experienced radiologists independently rated high-pitch CTCA images for quality using a four-point scale (1 = excellent, 4 = non-diagnostic) on a per-segment basis. The effective dose was calculated by multiplying the conversion coefficient of 0.028 by the dose–length product. Results The mean heart rate of patients was 57 ± 6 beats/min. For detecting >50% stenosis, the sensitivity, specificity, PPV, and NPV of high-pitch CTCA were 89, 97, 87, and 97% on a per-segment basis; 91, 92, 92, and 91% on a per-vessel basis; and 99, 85, 96, and 94% on a per-patient basis. For detecting >70% stenosis, the sensitivity, specificity, PPV, and NPV of high-pitch CTCA were 96, 98, 90, and 99% on a per-segment basis. Coronary segments were rated as diagnostic in 98.6% (1355/1375) of cases (score 1, 72.5%; score 2, 23.1%; score 3, 3%; score 4, 1.4%). The effective dose of high-pitch CTCA was 1.51 ± 0.31 mSv. Conclusion High-pitch prospectively ECG-triggering dual-source CTCA provides good image quality and high diagnostic accuracy with a 1.51 mSv radiation dose.

The purpose of this study is to investigate whether an iterative reconstruction in image space (IRIS) algorithm improves the image quality of dual-energy CT abdominal examinations performed during the hepatic arterial phase.Seventy patients with suspected liver masses underwent contrast-enhanced multiphase abdominal examination and were enrolled in the study. A dual-energy CT protocol was performed in the hepatic arterial phase (parameters: tube A, 140 kV and 90 mA; tube B, 80 kV and 382 mA; automatic tube current modulation on; and collimation, 14 × 1.2 mm). The reconstructions were performed with filtered back projection (FBP) and IRIS algorithms at a slice thickness of 3 mm and kernels of B30 and I30. The image noise was measured on the liver, aorta, and subcutaneous fat on the FBP and IRIS fusion images (m = 0.3) at the same position. The image noise and diagnostic acceptability of all images were scored by two radiologists.The image noise using the IRIS algorithm was lower than that using the standard FBP algorithm on the liver, aorta, and subcutaneous fat, respectively. The signal-to-noise ratio and contrast-to-noise ratio of images reconstructed with the IRIS algorithm also were significantly higher than for those reconstructed with the FBP algorithm. The diagnostic acceptability score using the IRIS algorithm was higher than that using the FBP algorithm at the same dose level (1.20 ± 0.40 vs 1.37 ± 0.57; p0.05).Compared with standard FBP reconstruction, an IRIS algorithm enables significant reduction of image noise and improvement of image quality and has the potential to decrease radiation exposure during contrast-enhanced dual-energy CT abdominal examination.

To investigate the image quality and dose performance of 80 kV high-pitch spiral (HPS) coronary CT angiography (CCTA). 106 patients consecutively enrolled into prospectively ECG-triggering HPS CCTA (pitch = 3.4) exam using kV/ref. mAs = 80/400, 100/370, and 120/370 when patient BMI was ≤22.5 (n = 40), between 22.5 and 27.5 (n = 53) and >27.5 kg/m² (n = 13). Image quality was assessed per-segment by two observers independently using a 4-point scale (1—excellent, 4—non-diagnosable). Image noise and signal-to-noise ratio (SNR), contrast-to-noise ratio were measured. Diagnostic image quality was obtained in 503 of 507, 687 of 693, 164 of 167 coronary segments in 80, 100, 120 kV groups without significant difference (P = 0.482). The proportions of segments with score 1–4 were not significantly different among three kV groups (all P > 0.05). Image noise were significantly higher in 80 kV group than 100 and 120 groups (P < 0.001), while SNR was not (P = 0.097). The effective dose of 80 kV group (0.36 ± 0.03 mSv) was significantly lower than that of 100 kV group (0.86 ± 0.08 mSv) and 120 kV group (1.77 ± 0.18 mSv). The mean ± SD of HR in all patients was 54.8 ± 5.1 bpm. 80 kV HPS CCTA is feasible for patient with BMI ≤ 22.5 kg/m² which can save 58% dose than 100 kV group, while maintain diagnosable image quality.

To investigate the radiation dose and image quality of prospective ECG-triggering dual-source CT angiography in infants with complex congenital heart disease (CHD) in comparison with retrospective ECG-gated scanning.Ninety-six infants less than 1 year old (60/36 male/female, age: 4.8 ± 2.7 months, weight: 5.8 ± 1.8 kg) with complex CHD were enrolled. Three image acquisition protocols were set: group 1: 80 kV, 100 mA, retrospective ECG-gated protocol; group 2: 80 kV, 100 mA, prospective ECG-triggering protocol with acquisition window of 380 ms; group 3: 80 kV, 100 mA, prospective ECG-triggering protocol with acquisition window of 200 ms. Patients were selected to any one of the protocols randomly. The signal-to-noise ratios (SNR) were calculated in the ascending aorta and the pulmonary artery trunk. Image quality was assessed by a five-point score. A score of3 represents non-diagnostic. Effective radiation dose (ED) was calculated.Image quality score of groups 1, 2 and 3 were 4.1 ± 0.4, 4.0 ± 0.6 and 4.2 ± 0.6 (p = 0.224). SNR of ascending aorta and pulmonary artery trunk among them had no statistical difference (all p0.05). The average ED (median) of groups 1, 2 and 3 were 1.17 ± 0.07 mSv (1.25 mSv), 0.72 ± 0.24 mSv (0.78 mSv) and 0.48 ± 0.41 mSv (0.39 mSv). Any two of the three groups had significant differences (all p0.001).Prospective ECG-triggering DSCT angiography associated with a significantly lower ED than retrospective protocol, while maintaining image quality for diagnosis. Prospective ECG-triggering DSCT angiography could be used as a very important second-line diagnostic tool in infants with complex CHD.

The purpose of this study was to evaluate and compare the diagnostic accuracy and radiation dose of dual-source computed tomographic (DSCT) coronary angiography for assessment of coronary artery disease using prospective electrocardiographic triggering and retrospective electrocardiographically (ECG) gated spiral scans. One hundred sixteen patients who had undergone dual-source computed tomography and conventional coronary angiography were enrolled in this study. Fifty-four patients were scanned using retrospective ECG-gated protocols (group 1) and 62 patients using prospective ECG-triggered protocols (group 2). Diagnostic accuracy, image quality, and effective dose were compared between groups 1 and 2. Conventional coronary angiography was used as the reference standard. In total 1,709 (98.2%) coronary segments in the 116 patients were assessable with adequate image quality. Sensitivities and specificities of diagnosing coronary heart disease (≥50% stenosis) in a patient-based analysis of DSCT data were 93.3% and 88.9% in group 1 and 96.4% and 85.7% in group 2, respectively (p=0.973 and 0.761). In vessel-based analysis, sensitivities and specificities were 77.4% and 94.1% in group 1 and 79.6% and 92.3% in group 2 (p=0.983 and 0.985). Overall averaged image quality scores (using 1- to 4-point scale) in groups 1 and 2 were 3.3 ± 0.4 and 3.5 ± 0.9, respectively (p=0.268). Prevalence of good (score 3.0) and excellent (score 4.0) image qualities of coronary vessels were 95.4% in group 1 and 92.4% in group 2 (p = 0.861). Effective doses were 8.82 ± 3.50 mSv (range 3.92 to 15.36) in group 1 and 2.95 ± 1.39 mSv (range 0.99 to 6.06) in group 2 (p0.001). In conclusion, DSCT prospective ECG-triggered coronary angiography has equivalent image quality and diagnostic value compared to that of retrospective ECG-gated scans. Radiation dose was significantly decreased using prospective electrocardiographic triggering.

To evaluate the diagnostic accuracy of dual-source CT (DSCT) prospective ECG-triggering coronary angiography in patients with different heart rate (HR).103 patients with suspected coronary artery disease underwent DSCT prospective ECG-triggered coronary angiography and invasive coronary angiography (ICA). The patients were grouped by HR during CT scans: low HR (≤60 bpm, n = 34); medium HR (60 HR ≤ 70 bpm, n = 36) and high HR (70 bpm, n = 33). The sensitivity and specificity of DSCT in detecting ≥50% stenosis were compared among subgroups where ICA was the gold standard. Image quality was scored using a 4-point scale.A total of 1,580 (95.9%) coronary artery segments were evaluable. Sensitivity and specificity were 82.8% and 98.4%, 88.3% and 98.7%, and 80.3% and 98.6% for different subgroups (all p 0.05). The overall area under the curve of the receiver-operating characteristic analysis was 0.94. The image quality scores were 3.1 ± 0.3, 3.1 ± 0.3 and 3.0 ± 0.4 for subgroups (p 0.05). The overall average effective radiation dose was 3.60 ± 1.60 mSv.DSCT coronary angiography with prospective ECG-triggering could be just as accurate in patients with medium to high HR compared to those with low HR.

Objective To evaluate the value of dual-source computed tomography (DSCT) in quantitatively measuring pulmonary arteries and major aortopulmonary collateral vessels in comparison with conventional angiographic (CA) on preoperative patients with pulmonary artery atresia and ventricular septal defect (PAA-VSD). Materials and methods Twenty PAA-VSD patients who had complete imaging data of DSCT, CA and echocardiography (ECHO) studies were retrospectively analyzed. Using final clinical diagnosis as the standard, results of DSCT, CA and ECHO on the detection of cardiac malformations, measurement of diameters of pulmonary artery and collateral vessel, as well as the values of McGoon ratio, pulmonary arterial index (PAI) and total neopulmonary arterial index (TNPAI) were derived and compared. Results In 20 patients, 51 of 54 (94.4%) cardiac malformations were visualized by DSCT, whereas 42 (77.8%) by ECHO ( p =0.027). Fourteen cases with aortopulmonary collateral vessels were all (100%) detected by DSCT, whereas 5 cases (35.7%) by ECHO ( p =0.001), and 13 cases (92.9%) by CA ( p =0.995). Sixteen cases with confluence of native pulmonary arteries were diagnosed by DSCT, whereas 10 cases by CA ( p =0.024). Measurement of the diameters of pulmonary arteries, collateral vessels, and descending aorta at the level of diaphragm were correlated well between DSCT and CA ( r =0.95–0.99). McGoon ratio (DSCT=1.18±0.60, CA=1.23±0.64), PAI (DSCT=130.96±99.38mm 2 /m 2 , CA=140.91±107.87mm 2 /m 2 ) and TNPAI (DSCT=160.31±125.62mm 2 /m 2 , CA=169.14±122.81mm 2 /m 2 ) were calculated respectively, without significant differences between DSCT and CA by paired t -tests (all p >0.05). Conclusion DSCT was efficient for evaluating and measuring native pulmonary artery and aortopulmonary collateral vessels prior to surgical procedures in PAA-VSD patients. Combined with echocardiography, DSCT showed potential to replace CA for evaluating pulmonary artery atresia noninvasively.

Diastolic Intervals and Alternans of APD. Introduction: Investigation of relationship between diastolic-interval (DI)-dependent restitution of action potential duration (APD) and alternans of APD has produced conflicting results. We used a novel pacing protocol to determine the role of restitution in alternans by minimizing changes in DI preceding each activation. Methods: Transmembrane potentials were recorded from right ventricular endocardial tissue isolated from five dogs. We used three pacing sequences: (i) The tissue was paced at a constant DI for 100 beats. (ii) The DIs were changed randomly between two sequences of constant DI. (iii) Each constant DI trial was followed by constant cycle length trial where pacing cycle length was equal to average cycle length during previous constant DI trial. Results: Alternans of APD occurred even when DIs preceding each activation were invariant. Slopes of restitution during constant DI pacing were both negative and positive and were much larger than unity. Alternans amplitude during constant cycle length pacing was larger than during constant DI, 32.2 ± 12.3 versus 7.5 ± 2.8 msec, P < 0.01. Random perturbation of DI decreased alternans amplitude during constant DI pacing from 14.7 ± 4.8 to 10.5 ± 3.4 msec, P < 0.01. Conclusion: Our results indicate that mechanism of repolarization alternans has restitution-dependent and restitution-independent components. However, our results also provide direct evidence that shows that DI-dependent restitution of APD is not a necessary mechanism for the alternans to exist. Ability to pace with explicit control of DI provides a novel approach to dissect mechanisms of alternans into restitution-dependent and restitution-independent effects.

We used a mathematical model to investigate effects of repolarizing currents I kr and I ks , calcium (Ca) current I CaL , and Ca dynamics in network sarcoplasmic reticulum and junctional sarcoplasmic reticulum (JSR) on hysteresis in restitution of action potential duration. Enhanced I kr increased slope of restitution, hysteresis loop thickness, and delay between peaks of diastolic intervals and action potential duration. Increase in I ks decreased loop thickness and peak delay. Decrease in I CaL had effects similar to increasing I kr , except slope of restitution decreased markedly. Uptake of Ca into the network sarcoplasmic reticulum had less effect on hysteresis than transfer of Ca into JSR. Faster transfer of Ca into JSR markedly decreased loop thickness and peak delay. Our results provide insight into mechanisms responsible for this newly identified property of restitution. Such information will be valuable in studies where modification of hysteresis is used to investigate its role in arrhythmogenesis.

Restitution of action potential duration (APD) is thought to be critical in activation instability. Although restitution is used to predict APD during sequential changes in diastolic interval (DI), currently used protocols to determine restitution do not use sequential changes in DI. We explored restitution using a new pacing protocol to change DI sequentially and independently of APD. Transmembrane potentials were recorded from right ventricular endocardial tissue isolated from six dogs. We used three patterns of DIs: oscillatory, to demonstrate differences in APDs depending on previous activation history; random, to minimize effects of previous activation history, each DI preceding an APD had an equal probability of being short or long; and linear, to compare restitution relationship obtained during sequential changes in DI with those obtained using currently used protocols; DIs mimicked those that resulted using currently used protocols, except that they changed in sequence. During oscillatory DIs, restitution showed bimodal trajectory similar to hysteresis. Decrease in APD during decreasing DIs was faster than increase in APD during increasing DIs. When effects of previous activation history were minimized, we observed that for a given DI there were multiple values of APD. Restitution relationship obtained during sequential changes in DI was shallower than those obtained using currently used protocols. Our results show that the new pacing protocol may permit direct evaluation of effects of memory on APD. Sequential and explicit control of DI suggests that use of a unimodal relationship to predict APD when DIs change in sequence may not be appropriate.