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Objective: The aim of this study was to evaluate the impact of ultra-high-resolution acquisition and deep learning reconstruction (DLR) on the image quality and diagnostic performance of T2-weighted periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) imaging of the rectum., Materials and Methods: This prospective study included 34 patients who underwent magnetic resonance imaging (MRI) for initial staging or restaging of rectal tumors. The following 4 types of oblique axial PROPELLER images perpendicular to the tumor were obtained: a standard 3-mm slice thickness with conventional reconstruction (3-CR) and DLR (3-DLR), and 1.2-mm slice thickness with CR (1.2-CR) and DLR (1.2-DLR). Three radiologists independently evaluated the image quality and tumor extent by using a 5-point scoring system. Diagnostic accuracy was evaluated in 22 patients with rectal cancer who underwent surgery after MRI without additional neoadjuvant therapy (median interval between MRI and surgery, 22 days). The signal-to-noise ratio and tissue contrast were measured on the 4 types of PROPELLER imaging., Results: 1.2-DLR imaging showed the best sharpness, overall image quality, and rectal and lesion conspicuity for all readers ( P < 0.01). Of the assigned scores for tumor extent, extramural venous invasion (EMVI) scores showed moderate agreement across the 4 types of PROPELLER sequences in all readers (intraclass correlation coefficient, 0.60-0.71). Compared with 3-CR imaging, the number of cases with MRI-detected extramural tumor spread was significantly higher with 1.2-DLR imaging (19.0 ± 2.9 vs 23.3 ± 0.9, P = 0.03), and the number of cases with MRI-detected EMVI was significantly increased with 1.2-CR, 3-DLR, and 1.2-DLR imaging (8.0 ± 0.0 vs 9.7 ± 0.5, 11.0 ± 2.2, and 12.3 ± 1.7, respectively; P = 0.02). For the diagnosis of histopathologic extramural tumor spread, 3-CR and 1.2-CR had significantly higher specificity than 3-DLR and 1.2-DLR imaging (0.75 and 0.78 vs 0.64 and 0.58, respectively; P = 0.02), and only 1.2-CR had significantly higher accuracy than 3-CR imaging (0.83 vs 0.79, P = 0.01). The accuracy of MRI-detected EMVI with reference to pathological EMVI was significantly lower for 3-CR and 3-DLR compared with 1.2-CR (0.77 and 0.74 vs 0.85, respectively; P < 0.01), and was not significantly different between 1.2-CR and 1.2-DLR (0.85 vs 0.80). Using any pathological venous invasion as the reference standard, the accuracy of MRI-detected EMVI was significantly the highest with 1.2-DLR, followed by 1.2-CR, 3-CR, and 3-DLR (0.71 vs 0.67 vs 0.59 vs 0.56, respectively; P < 0.01). The signal-to-noise ratio was significantly highest with 3-DLR imaging ( P < 0.05). There were no significant differences in tumor-to-muscle contrast between the 4 types of PROPELLER imaging., Conclusions: Ultra-high-resolution PROPELLER T2-weighted imaging of the rectum combined with DLR improved image quality, increased the number of cases with MRI-detected extramural tumor spread and EMVI, but did not improve diagnostic accuracy with respect to pathology in rectal cancer, possibly because of false-positive MRI findings or false-negative pathologic findings., Competing Interests: Conflicts of interest and sources of funding: none declared. The Department of Radiology, Osaka University Graduate School of Medicine and Osaka University Hospital received support from GE Healthcare for equipment related to this study, and payment for travel to meetings or other activities not related to this study. Two of the authors are employees of GE Healthcare., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Photon-counting CT has a completely different detector mechanism than conventional energy-integrating CT. In the photon-counting detector, X-rays are directly converted into electrons and received as electrical signals. Photon-counting CT provides virtual monochromatic images with a high contrast-to-noise ratio for abdominal CT imaging and may improve the ability to visualize small or low-contrast lesions. In addition, photon-counting CT may offer the possibility of reducing radiation dose. This review provides an overview of the actual clinical operation of photon-counting CT and its diagnostic utility in abdominal imaging. We also describe the clinical implications of photon-counting CT including imaging of hepatocellular carcinoma, liver metastases, hepatic steatosis, pancreatic cancer, intraductal mucinous neoplasm of the pancreas, and thrombus., (© 2024. The Author(s).)

Purpose: Liver and pancreatic fibrosis is associated with diabetes mellitus (DM), and liver fibrosis is associated with pancreatic fibrosis. This study aimed to investigate the relationship between the hepatic and pancreatic extracellular volume fractions (fECVs), which correlate with tissue fibrosis, and their relationships with DM and pre-DM (pDM)., Material and Methods: We included 100 consecutive patients with known or suspected liver and/or pancreatic diseases who underwent contrast-enhanced CT. Patients were classified as nondiabetes, pDM, and DM with hemoglobin A1c (HbA1c) levels of < 5.7%, 5.7%-6.5%, and ≥ 6.5% or fasting plasma glucose (FPG) levels of < 100, 100-125 mg/dL, and ≥ 126 mg/dL, respectively. Subtraction images between unenhanced and equilibrium-phase images were prepared. The liver and the pancreas were automatically extracted using a high-speed, three-dimensional image analysis system, and their respective mean CT values were calculated. The enhancement degree of the aorta (Δaorta) was measured. fECV was calculated using the following equation: fECV = (100 - hematocrit) * Δliver or pancreas/Δaorta. Differences were investigated in hepatic and pancreatic fECVs among the three groups, and the correlation between each two in hepatic fECV, pancreatic fECV, and HbA1c was determined., Results: The pancreatic fECV, which was positively correlated with the hepatic fECV and HbA1c (r = 0.51, P < 0.001, and r = 0.51, P < 0.001, respectively), significantly differed among the three groups (P < 0.001) and was significantly greater in DM than in pDM or nondiabetes and in pDM with nondiabetes (P < 0.001). Hepatic fECV was significantly greater in DM than in nondiabetes (P < 0.05)., Conclusion: The pancreatic fECV and pDM/DM are closely related., (© 2024. The Author(s).)

Purpose: To compare the effects of deep learning reconstruction (DLR) on respiratory-triggered T2-weighted MRI of the liver between single-shot fast spin-echo (SSFSE) and fast spin-echo (FSE) sequences., Methods: Respiratory-triggered fat-suppressed liver T2-weighted MRI was obtained with the FSE and SSFSE sequences at the same spatial resolution in 55 patients. Conventional reconstruction (CR) and DLR were applied to each sequence, and the SNR and liver-to-lesion contrast were measured on FSE-CR, FSE-DLR, SSFSE-CR, and SSFSE-DLR images. Image quality was independently assessed by three radiologists. The results of the qualitative and quantitative analyses were compared among the four types of images using repeated-measures analysis of variance or Friedman's test for normally and non-normally distributed data, respectively, and a visual grading characteristics (VGC) analysis was performed to evaluate the image quality improvement by DLR on the FSE and SSFSE sequences., Results: The liver SNR was lowest on SSFSE-CR and highest on FSE-DLR and SSFSE-DLR (P < 0.01). The liver-to-lesion contrast did not differ significantly among the four types of images. Qualitatively, noise scores were worst on SSFSE-CR but best on SSFSE-DLR because DLR significantly reduced noise (P < 0.01). In contrast, artifact scores were worst both on FSE-CR and FSE-DLR (P < 0.01) because DLR did not reduce the artifacts. Lesion conspicuity was significantly improved by DLR compared with CR in the SSFSE (P < 0.01) but not in FSE sequences for all readers. Overall image quality was significantly improved by DLR compared with CR for all readers in the SSFSE (P < 0.01) but only one reader in the FSE (P < 0.01). The mean area under the VGC curve values for the FSE-DLR and SSFSE-DLR sequences were 0.65 and 0.94, respectively., Conclusion: In liver T2-weighted MRI, DLR produced more marked improvements in image quality in SSFSE than in FSE.

Oncogene-induced replication stress is a crucial driver of genomic instability and one of the key events contributing to the onset and evolution of cancer. Despite its critical role in cancer, the mechanisms that generate oncogene-induced replication stress remain not fully understood. Here, we report that an oncogenic c-Myc-dependent increase in cohesins on DNA contributes to the induction of replication stress. Accumulation of cohesins on chromatin is not sufficient to cause replication stress, but also requires cohesins to accumulate at specific sites in a CTCF-dependent manner. We propose that the increased accumulation of cohesins at CTCF site interferes with the progression of replication forks, contributing to oncogene-induced replication stress. This is different from, and independent of, previously suggested mechanisms of oncogene-induced replication stress. This, together with the reported protective role of cohesins in preventing replication stress-induced DNA damage, supports a double-edge involvement of cohesins in causing and tolerating oncogene-induced replication stress., (© 2024. The Author(s).)

Purpose: To compare objective and subjective image quality, lesion conspicuity, and apparent diffusion coefficient (ADC) of high-resolution multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE-DWI) with conventional DWI (c-DWI) and reduced FOV DWI (rFOV-DWI) in prostate MRI., Methods: Forty-seven patients who underwent prostate MRI, including c-DWI, rFOV-DWI, and MUSE-DWI, were retrospectively evaluated. SNR and ADC of normal prostate tissue and contrast-to-noise ratio (CNR) and ADC of prostate cancer (PCa) were measured and compared between the three sequences. Image quality and lesion conspicuity were independently graded by two radiologists using a 5-point scale and compared between the three sequences., Results: The SNR of normal prostate tissue was significantly higher with rFOV-DWI than with the other two DWI techniques (P ≤ 0.01). The CNR of the PCa was significantly higher with rFOV-DWI than with MUSE-DWI (P < 0.05). The ADC of normal prostate tissue measured by rFOV-DWI was lower than that measured by MUSE-DWI and c-DWI (P < 0.01), while there was no difference in the ADC of cancers. In the qualitative analysis, MUSE-DWI showed significantly higher scores than rFOV-DWI and c-DWI for visibility of anatomy and overall image quality in both readers, and significantly higher scores for distortion in one of the two readers (P < 0.001). There was no difference in lesion conspicuity between the three sequences., Conclusion: High-resolution MUSE-DWI showed higher image quality and reduced distortion compared to c-DWI, while maintaining a wide FOV and similar ADC quantification, although no difference in lesion conspicuity was observed.

Objective: To evaluate the image quality and lesion detectability of pancreatic phase thin-slice computed tomography (CT) images reconstructed with a deep learning-based reconstruction (DLR) algorithm compared with filtered-back projection (FBP) and hybrid iterative reconstruction (IR) algorithms., Methods: Fifty-three patients who underwent dynamic contrast-enhanced CT including pancreatic phase were enrolled in this retrospective study. Pancreatic phase thin-slice (0.625 mm) images were reconstructed with each FBP, hybrid IR, and DLR. Objective image quality and signal-to-noise ratio of the pancreatic parenchyma, and contrast-to-noise ratio of pancreatic lesions were compared between the 3 reconstruction algorithms. Two radiologists independently assessed the image quality of all images. The diagnostic performance for the detection of pancreatic lesions was compared among the reconstruction algorithms using jackknife alternative free-response receiver operating characteristic analysis., Results: Deep learning-based reconstruction resulted in significantly lower image noise and higher signal-to-noise ratio and contrast-to-noise ratio than hybrid IR and FBP ( P < 0.001). Deep learning-based reconstruction also yielded significantly higher visual scores than hybrid IR and FBP ( P < 0.01). The diagnostic performance of DLR for detecting pancreatic lesions was highest for both readers, although a significant difference was found only between DLR and FBP in one reader ( P = 0.02)., Conclusions: Deep learning-based reconstruction showed improved objective and subjective image quality of pancreatic phase thin-slice CT relative to other reconstruction algorithms and has potential for improving lesion detectability., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To compare the image quality of high-resolution diffusion-weighted imaging (DWI) using multiplexed sensitivity encoding (MUSE) versus reduced field-of-view (rFOV) techniques in endometrial cancer (EC) and to compare the diagnostic performance of these techniques with that of dynamic contrast-enhanced (DCE) MRI for assessing myometrial invasion of EC., Methods: MUSE-DWI and rFOV-DWI were obtained preoperatively in 58 women with EC. Three radiologists assessed the image quality of MUSE-DWI and rFOV-DWI. For 55 women who underwent DCE-MRI, the same radiologists assessed the superficial and deep myometrial invasion using MUSE-DWI, rFOV-DWI, and DCE-MRI. Qualitative scores were compared using the Wilcoxon signed-rank test. Receiver operating characteristic analysis was performed to compare the diagnostic performance., Results: Artifacts, sharpness, lesion conspicuity, and overall quality were significantly better with MUSE-DWI than with rFOV-DWI (p < 0.05). The area under the curve (AUC) of MUSE-DWI, rFOV-DWI, and DCE-MRI for the assessment of myometrial invasion were not significantly different except for significantly higher AUC of MUSE-DWI than that of DCE-MRI for superficial myometrial invasion (0.76 for MUSE-DWI and 0.64 for DCE-MRI, p = 0.049) and for deep myometrial invasion (0.92 for MUSE-DWI and 0.80 for DCE-MRI, p = 0.022) in one observer, and that of rFOV-DWI for deep myometrial invasion in another observer (0.96 for MUSE-DWI and 0.89 for rFOV-MRI, p = 0.048)., Conclusion: MUSE-DWI exhibits better image quality than rFOV-DWI. MUSE-DWI and rFOV-DWI shows almost equivalent diagnostic performance compared to DCE-MRI for assessing superficial and deep myometrial invasion in EC although MUSE-DWI may be helpful for some radiologists., (© 2023. Italian Society of Medical Radiology.)

Although nuclear imaging can detect cardiac involvement of cardiac sarcoidosis (CS), including subclinical states, little is known about the prevalence and outcomes of radiologic relapse under prednisolone (PSL) therapy. This study aimed to investigate the clinical characteristics and outcomes in patients with radiologic relapse. A total of 80 consecutive patients with CS whose disease activity on nuclear imaging decreased at least once after initiation of immunosuppressive therapy were identified through a retrospective chart review. Radiologic relapse of CS was diagnosed using 18 F-fluoro-2-deoxyglucose positron emission tomography or gallium-67 scintigraphy. Composite adverse events were defined as at least 1 of the following: all-cause death, hospitalization for heart failure, or lethal arrhythmia. During the follow-up period (median 2.9 years), radiologic relapse was observed in 31 patients (38.8% of overall patients) at 30 months (median) after immunosuppressive therapy initiation. After radiologic relapse was detected, all patients were treated with intensified immunosuppressive therapies (increasing PSL, n = 26 [83.9%], adding other immunosuppressive therapies to PSL, n = 5 [16.1%]). There were no differences in occurrences of composite adverse events in patients with and patients without radiologic relapse. Radiologic relapse under immunosuppressive therapy was observed in many patients with CS, but it was not associated with clinical outcomes under intensified immunosuppressive therapy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The JSNC-ASNC joint symposium in the 33 rd JSNC annual meeting was held on Jun. 24 th , and we invited Prof. Mouaz H. Al-Mallah, who was the president of ASNC and requested the lecture entitled "Comparison of MPI and FFR CT ". He introduced several cases and evidences reported previously, and summarized the current status of FFR CT , especially about the diagnostic performance, prognostic value, and proper use, compared to MPI., Competing Interests: None., (© The Japanese Society of Nuclear Cardiology 2023.)

Patient positioning at the isocenter of the CT gantry is important for optimizing image quality and radiation dose, but accurate positioning is challenging in pediatric patients. We evaluated whether the high-resilience pad and pre-scan measurement of chest thickness allow accurate positioning in pediatric patients with congenital heart disease. Sixty-seven patients aged 7 years or younger who underwent cardiothoracic CT were enrolled. The ideal table height, defined as the position at which the scanner's and patient's isocenters coincided, was determined by radiographers either manually (manual group) or based on the pad's and chest's thickness (calculated group). The distance between the two isocenters and image quality were evaluated. The calculated group demonstrated smaller isocenter distance and standard deviation (distance: 0.2 ± 5.8 mm vs. - 8.3 ± 11.6 mm, p < 0.01; absolute value: 4.1 [1.9-8.0] mm vs. 12.3 [5.1-16.3] mm, p < 0.01), and higher signal-to-noise ratio (SNR) and dose-normalized SNR (SNRD) in the descending aorta than the manual group (SNR: 39.8 [31.0-53.7] vs. 31.9 [28.9-36.6], p = 0.048, SNRD: 39.8 [31.0-53.7] vs. 31.9 [28.9-36.6], p = 0.04). The system allowed for more accurate positioning in pediatric cardiothoracic CT, yielding higher image quality., (© 2022. The Author(s).)

A coronavirus disease 2019 (COVID-19) outbreak in a psychiatry hospital revealed specific challenges in its response such as difficulty in isolation, transfer, and identification of close contacts, suboptimal infection control practices, and shortage of personal protective equipment, which were overcome by support from the public health center and a neighboring university hospital., (© The Author(s) 2022.)

The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial has had a great impact on the management of chronic coronary artery disease (CAD). One of the implications of this trial is the importance of close patient follow-up. To improve patient prognosis, evaluation of the residual extent of ischemia after treatment may be important because several studies have shown a close relationship between residual ischemia and cardiac events. For this assessment, myocardial perfusion single-photon emission computed tomography (MPS) has been utilized and is almost the only modality. Among the participants in the ISCHEMIA trial, more than 10% were excluded due to the absence of obstructive CAD. The pathophysiology of ischemia without non-obstructive coronary artery disease (INOCA) is gaining recognition; however, diagnosis is difficult, except for the assessment of myocardial flow reserve (MFR). Myocardial perfusion positron emission tomography (PET) is the most common modality for noninvasive evaluation of MFR; however, its availability in Japan is limited. For a breakthrough in this situation, a novel gamma camera with a cadmium zinc telluride (CZT) semiconductor might be one of the solutions that enables the evaluation of MFR with a commercially available perfusion tracer, similar to PET. Another solution is a novel PET tracer with a longer half-life. Clinical trials with 18 F labeled perfusion agents have been initiated in Japan, and in a few years, delivery of this perfusion tracer will result in more frequent and easier assessment of MFR., Competing Interests: None., (2022, Japanese Society of Nuclear Cardiology.)

Background: The optimal right ventricular (RV) pacing site during pacemaker implantation is still unclear due to left ventricular (LV) dyssynchrony by traditional RV pacing. His-bundle (HIS) pacing has achieved narrow QRS and maintained LV synchrony but high failure rate. RV septal pacing occasionally has QRS waveform with wide and narrow component in the early and late phase, respectively, and maintains LV synchrony, reflecting the normal conduction system. We aimed to define this QRS waveform as retrograde penetration pacing into the conduction system (RPP-CS) and compared its effect on LV synchrony as an alternative approach of HIS pacing., Methods and Results: We enrolled 42 patients with atrio ventricular block (AVB) or bradycardia atrial fibrillation (AF) requiring pacemaker implantation (RPP-CS, n = 27; no RPP-CS, n = 15). Baseline characteristics were similar between the groups. RPP-CS was observed in 96% and 26% of the RV septum and apex area, respectively. RPP-CS had a significantly shorter QRS width (p < 0.001). The frequency of maintaining LV synchrony was significantly higher in RPP-CS (67% vs. 20%, p = 0.003). The QRS interval's optimal cut-off value during RPP-CS was 132 ms for prediction of LV synchrony (sensitivity 83%, specificity 89%, positive predictive value 94%, and negative predictive value 73%). During RPP-CS, shorter QRS intervals (QRS ≤ 132 ms) had better postoperative LV ejection fraction than longer intervals (p < 0.001)., Conclusions: RPP-CS, especially with short QRS intervals (≤132 ms), had a high frequency of LV synchrony, maintained postoperative cardiac function, and may be an adequate first-line RV pacing site strategy for AVB or bradycardia AF as an alternative approach of HIS pacing., Competing Interests: Declaration of Competing Interest K. Kusano, T. Noda, and K. Ishibashi received honoraria for lectures from Medtronic Japan Co., Ltd. The other authors have no conflict of interests to declare., (Copyright © 2021. Published by Elsevier Ltd.)

Objective : A working group (WG) of the Japanese Society of Nuclear Cardiology (JSNC) determined Japanese normal databases of myocardial perfusion single-photon emission computed tomography (SPECT) on semi-conductor gamma camera (D-SPECT), and the aim of this study was to validate its clinical utility. Materials and methods : The normal myocardial perfusion SPECT (MPS) databases of Japanese patients in the 201 Tl stress/redistribution protocol ( 201 Tl protocol), 99m Tc stress/rest or rest/stress protocol ( 99m Tc protocol), and rest 99m Tc/stress 201 Tl simultaneous acquisition dual-isotope protocol (SDI protocol) were created by JSNC WG. The WG collected clinical cases for the 201 Tl protocol (male/female [m/f], 8/8), 99m Tc protocol (m/f, 9/7), and SDI protocol (m/f, 10/10) from WG participating hospitals. Four WG members read those clinical cases on a 17-segment and 5-point scale (0-4). Using the most frequent values as the score for each segment, weighted κ values were calculated with the scores obtained from quantitative perfusion software (QPS). Results : Weighted κ values were as follows; 201 Tl stress/female, 0.77; 201 Tl rest/female, 0.74; 201 Tl stress/male, 0.81; 201 Tl rest/male, 0.68; 99m Tc stress/female, 0.77; 99m Tc rest/female, 0.62; 99m Tc stress/male, 0.77; 99m Tc rest/male, 0.75; SDI stress/female, 0.87; SDI rest/female, 0.82; SDI stress/male, 0.87; SDI rest/male, 0.85. Conclusions : The diagnostic accuracy of Japanese MPS normal databases on D-SPECT were comparable with nuclear cardiology expert reading and further clinical applications are expected., Competing Interests: N. Matsumoto received lecture fees from Nihon Medi-Physics, Tokyo, Japan and PDRadiopharma, Tokyo, Japan, and had a scholarship fund from PDRadiopharma. K. Nakajima has collaborative research with Spectrum Dynamics Medical, Israel, and belongs to endowed department partly funded by PDRadiopharma, Tokyo, Japan; Nihon Medi-Physics, Tokyo, Japan; and Siemens Healthcare, Tokyo, Japan., (2022, Japanese Society of Nuclear Cardiology.)

Epithelial barriers that prevent dehydration and pathogen invasion are established by tight junctions (TJs), and their disruption leads to various inflammatory diseases and tissue destruction. However, a therapeutic strategy to overcome TJ disruption in diseases has not been established because of the lack of clinically applicable TJ-inducing molecules. Here, we found TJ-inducing peptides (JIPs) in mice and humans that corresponded to 35 to 42 residue peptides of the C terminus of alpha 1-antitrypsin (A1AT), an acute-phase anti-inflammatory protein. JIPs were inserted into the plasma membrane of epithelial cells, which promoted TJ formation by directly activating the heterotrimeric G protein G13. In a mouse intestinal epithelial injury model established by dextran sodium sulfate, mouse or human JIP administration restored TJ integrity and strongly prevented colitis. Our study has revealed TJ-inducing anti-inflammatory physiological peptides that play a critical role in tissue repair and proposes a previously unidentified therapeutic strategy for TJ-disrupted diseases.

A 54-year-old woman had been resuscitated after ventricular fibrillation and her electrocardiogram showed a QT prolongation (QTc=510 ms), and genetic screening revealed a missense variant, R1644C, in the SCN5A gene. She was therefore diagnosed with congenital long-QT syndrome (LQTS) type 3. However, the patient had left ventricular dysfunction, and based on the findings of cardiac magnetic resonance imaging, positron emission tomography and pathological examinations, she was diagnosed with cardiac sarcoidosis. Although both are rare diseases, their overlapping presence in this case may have led to an increased cardiovascular risk compared with either alone. Thus, not only genetic but comprehensive clinical examinations are important for making a correct diagnosis.

Competing Interests: None.

Background: Myocardial scarring is associated with nonresponse to cardiac resynchronization therapy (CRT) and conduction delay. Little is known about the significance and cause of left ventricular (LV) paced conduction disturbance (LPCD)., Objective: The purpose of this study was to investigate the clinical impact of paced interlead electrical delay and the difference in each conduction time from LV pace to right ventricular (RV) sense (LVp-RVs) and from RV pace to LV sense (RVp-LVs) [(LVp-RVs) - (RVp-LVs)], in CRT., Methods: Among 137 patients who underwent CRT implantation, LVp-RVs and RVp-LVs were measured intraoperatively. The relationships between [(LVp-RVs) - (RVp-LVs)] and perfusion defects on myocardial perfusion single photon emission computed tomography (SPECT) imaging or [(LVp-RVs) - (RVp-LVs)] and clinical outcomes were assessed., Results: After CRT implantation, 81 patients (59%) responded to CRT. [(LVp-RVs) - (RVp-LVs)] was significantly longer in nonresponders than in responders (9.7 ± 47.3 ms vs -4.5 ± 33.2 ms; P = .041). Patients with LPCD [(LVp-RVs) > (RVp-LVs)] had higher perfusion defects in the anterolateral region (2.7 ± 2.7 vs 1.1 ± 1.6; P = .0015) on SPECT. Multivariate analysis showed that LPCD was the independent predictor of nonresponse to CRT (odds ratio 0.40; 95% confidence interval [CI] 0.17-0.90; P = .026). During median follow-up of 2.3 years (interquartile range 1.3-5.5), LPCD was the independent predictor of cardiac death and/or heart failure hospitalization in multivariate analysis (hazard ratio 2.04; 95% CI 1.19-3.55; P = .010)., Conclusion: LPCD could predict nonresponse to CRT and poor outcome. Further intervention, such as adjustment of pacing timing or multipoint/site pacing, may be needed in such patients., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Background : Abacus experts could mentally calculate fast some mathematical operations using multi-digit numbers. The temporal dynamics of abacus mental calculation are still unknown although some behavioral and neuroimaging studies have suggested a visuospatial and visuomotor neural process during abacus mental calculation. Therefore, this contribution aims to clarify the significant similarities and the differences between experts and novices by investigating calculation-induced neuromagnetic responses based on cerebral oscillatory changes. Methods : Twelve to 13 healthy abacus experts and 17 non-experts participated in two experimental paradigms using non-invasive neuromagnetic measurements. In experiments 1 and 2, the spatial distribution of oscillatory changes presented mental calculations and temporal frequency profiles during addition while examining multiplication tasks. The MEG data were analyzed using synthetic aperture magnetometry (SAM) with an adaptive beamformer to calculate the group average of the spatial distribution of oscillatory changes and their temporal frequency profiles in source-level analyses. Results : Using a group average of the spatial distribution of oscillatory changes, we observed some common brain activities in both right-handed abacus experts and non-experts. In non-experts, we detected the right dorsolateral prefrontal cortex (DLPFC) and bilateral Intraparietal sulcus (IPS); whereas in experts, detected the bilateral parieto-occipital sulcus (POS), right inferior frontal gyrus (IFG), and left sensorimotor areas mainly. Based on the findings generated, we could propose calculation processing models for both abacus experts and non- experts conveniently. Conclusion : The proposed model of calculation processing in abacus experts and novices revealed that the novices could calculate logically depending on numerical processing in the left IPS. In contrast, abacus experts are utilizing spatial processing using a memorized imaginary abacus, which distributed over the bilateral hemispheres in the IFG and sensorimotor areas., (Copyright © 2020 Belkacem, Kiso, Uokawa, Goto, Yorifuji and Hirata.)

Background : Myocardial 18 F-fluorodeoxyglucose ( 18 F-FDG) uptake is a sign of active inflammation in patients with cardiac sarcoidosis (CS) under the correct circumstance. However, even under the proper preparation, diffuse myocardial 18 F-FDG uptake is frequently observed in the failing heart and misleads the CS disease activity. The aim of this study was to establish the diagnostic value of resting myocardial perfusion single photon emission computed tomography (SPECT) for assessing CS disease activity in patients with diffuse myocardial 18 F-FDG uptake. Methods : We examined 39 patients with either histologically or clinically proven CS. All patients underwent 18 F-FDG positron emission tomography (PET) and resting 99m Tc-SPECT. The presence of perfusion-metabolic mismatch was evaluated with generating polar maps of 18 F-FDG PET and 99m Tc-SPECT images. Results : Increased myocardial 18 F-FDG uptake was observed in 33 (85%) of 39 patients. Focal 18 F-FDG uptake was detected in 16 patients and diffuse 18 F-FDG uptake was seen in 17 patients. Brain natriuretic peptide (BNP) levels were significantly higher in patients with diffuse 18 F-FDG uptake than those with focal 18 F-FDG uptake (p=0.002). With comparing polar maps of 18 F-FDG PET and 99m Tc-SPECT images, 8 of 16 patients with diffuse 18 F-FDG uptake and myocardial perfusion defects demonstrated perfusion-metabolic mismatch which represented active inflammatory lesions in CS. Conclusions : Simultaneous evaluation of myocardial 18 F-FDG PET and 99m Tc-SPECT by polar map analysis provides more relevant information for assessing disease activity in CS than 18 F-FDG PET images alone. Perfusion-metabolic mismatch might indicate latent active inflammation in CS patients with diffuse myocardial 18 F-FDG uptake, who had advanced heart failure., Competing Interests: None of the authors have any conflicts of interest to declare., (© The Japanese Society of Nuclear Cardiology 2020.)

Background: Percutaneous driveline infection is a major complication of left ventricular assist device (LVAD). This study evaluated the role of gallium-67 single-photon emission computed tomography (Ga-SPECT)-CT in LVAD-specific percutaneous driveline infection., Methods: Thirty-six patients with implantable continuous-flow LVAD, who underwent Ga-SPECT-CT to evaluate percutaneous driveline infections, were enrolled and divided into uptake and no-uptake groups based on tracer concentration uptake on Ga-SPECT-CT. Primary outcomes were surgical intervention and readmission for driveline infection., Results: Twenty-two patients had uptake on Ga-SPECT-CT. No significant differences were noted in patient characteristics, wound appearance, or laboratory results. The prevalence of positive skin culture at the driveline exit site (DLES), and usage and duration of antibiotics did not differ. However, the uptake group had higher 1-year event rates (surgical intervention: 39% vs 0%, P = .019; readmission: 74% vs 6.9%, P = .0016). In addition to positive skin culture at DLES and short duration of antibiotic therapy, uptake on Ga-SPECT-CT was a risk factor for surgical intervention (odds ratio 9.00; P = .018) and readmission (odds ratio 7.86; P = .0051)., Conclusions: Ga-SPECT-CT could be one of the clinical modalities for guiding the treatment of driveline infection in patients with a LVAD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Microtubule-associated protein 1 light chain 3 α (LC3)/GABA type A receptor-associated protein (GABARAP) comprises a family of ubiquitin-like proteins involved in (macro)autophagy, an important intracellular degradation pathway that delivers cytoplasmic material to lysosomes via double-membrane vesicles called autophagosomes. The only currently known cellular molecules covalently modified by LC3/GABARAP are membrane phospholipids such as phosphatidylethanolamine in the autophagosome membrane. Autophagy-related 4 cysteine peptidase (ATG4) proteases process inactive pro-LC3/GABARAP before lipidation, and the same proteases can also deconjugate LC3/GABARAP from lipids. To determine whether LC3/GABARAP has other molecular targets, here we generated a pre-processed LC3B mutant (Q116P) that is resistant to ATG4-mediated deconjugation. Upon expression in human cells and when assessed by immunoblotting under reducing and denaturing conditions, deconjugation-resistant LC3B accumulated in multiple forms and at much higher molecular weights than free LC3B. We observed a similar accumulation when pre-processed versions of all mammalian LC3/GABARAP isoforms were expressed in ATG4-deficient cell lines, suggesting that LC3/GABARAP can attach also to other larger molecules. We identified ATG3, the E2-like enzyme involved in LC3/GABARAP lipidation, as one target of conjugation with multiple copies of LC3/GABARAP. We show that LC3B-ATG3 conjugates are distinct from the LC3B-ATG3 thioester intermediate formed before lipidation, and we biochemically demonstrate that ATG4B can cleave LC3B-ATG3 conjugates. Finally, we determined ATG3 residue Lys-243 as an LC3B modification site. Overall, we provide the first cellular evidence that mammalian LC3/GABARAP post-translationally modifies proteins akin to ubiquitination ("LC3ylation"), with ATG4 proteases acting like deubiquitinating enzymes to counteract this modification ("deLC3ylation")., (© 2019 Agrotis et al.)

Background: Sudden death can occur in some patients with non-sustained ventricular tachycardia (NSVT) after myocardial infarction (MI) in those with coronary artery lesions (CAL) caused by Kawasaki disease (KD). The aim of this study was to determine the risk factors for NSVT in the late period after KD by technetium-99m-tetrofosmin myocardial perfusion imaging (MPI)., Methods: We retrospectively analyzed the relation between the appearance of NSVT and the findings in MPI single-photon-emission computed tomography (SPECT) in 75 patients (55 males and 20 females) who had had CAL caused by KD. All the patients had undergone MPI and 24-h Holter electrocardiogram at the same time between 2003 and 2012. The age at MPI ranged from 2 to 44 years (median 19 years), and the time from the onset of KD to MPI ranged from 1 to 44 years (median 18 years). We evaluated extent score (ES), summed rest score (SRS), summed stress score (SSS), summed difference score (SDS), and left ventricular ejection fraction (LVEF) by quantitative gated SPECT software. We analyzed which factors related to NSVT using multivariate logistic regression. Further, we calculated the cut-off point for NSVT using receiver operating characteristic curve., Results: The affecting factors were ES (OR, 0.63, 95%CI, 0.35-0.92, p=0.013) and the interval from the onset of KD to MPI (OR, 0.82, 95%CI, 0.69-0.96, p=0.004). The cut-off points for ES and the interval from the onset of KD were 11% (AUC, 0.931, p<0.001) and 18 years (AUC, 0.732, p=0.007), respectively., Conclusions: ES is the strongest parameter for predicting NSVT in the late period. In patients with post-KD, adolescence and young adults with ES ≥11% are at risk of fatal ventricular arrhythmia., (Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

In embryonic stem cells (ESCs), the expression of development-related genes, including germ cell-related genes, is globally repressed. The transcription factor MAX represses germ cell-related gene expression in ESCs via PCGF6-polycomb repressive complex 1 (PRC1), which consists of several epigenetic factors. However, we predicted that MAX represses germ cell-related gene expression through several additional mechanisms because PCGF6-PRC1 regulates the expression of only a subset of genes repressed by MAX. Here, we report that MAX associated with DNA methyltransferases (DNMTs) and the histone methyltransferase SETDB1 cooperatively control germ cell-related gene expression in ESCs. Both DNA methylation and histone H3 lysine 9 tri-methylation of the promoter regions of several germ cell-related genes were not affected by knockout of the PRC1 components, indicating that the MAX-DNMT and MAX-SETDB1 pathways are independent of the PCGF6-PRC1 pathway. Our findings provide insights into our understanding of MAX-based repressive mechanisms of germ cell-related genes in ESCs., Competing Interests: IM is employed by and received salary from HaploPharma Inc., Chuo-ku, Tokyo, Japan. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials.

Aim: Whether myocardial ischemia identified using myocardial perfusion imaging (MPI) can be an alternative target of coronary revascularization to reduce the incidence of cardiac events remains unclear., Methods and Results: This multicenter, prospective cohort study aimed to clarify the prognostic impact of reducing myocardial ischemia. Among 494 registered patients with possible or definite coronary artery disease (CAD), 298 underwent initial pharmacological stress 99m Tc-tetrofosmin MPI before, and eight months after revascularization or medical therapy, and were followed up for at least one year. Among these, 114 with at least 5% ischemia at initial MPI were investigated. The primary endpoints were cardiac death, non-fatal myocardial infarction and hospitalization for heart failure. Ischemia was reduced ≥5% in 92 patients. Coronary revascularization reduced ischemia (n = 89) more effectively than medical therapy (n = 25). Post-stress cardiac function also improved after coronary revascularization. Ejection fraction significantly improved at stress (61.0% ± 10.7% vs. 65.4% ± 11.3%; p < 0.001) but not at rest (67.1% ± 11.3% vs. 68.3% ± 11.6%; p = 0.144), among patients who underwent revascularization. Rates of coronary revascularization and cardiac events among the 114 patients were significantly higher (13.6%, p = 0.035) and lower (1.1% p = 0.0053), respectively, in patients with, than without ≥5% ischemia reduction. Moreover, patients with complete resolution of ischemia at the time of the second MPI had a significantly better prognosis., Conclusions: Reducing ischemia by ≥5% and the complete resolution of ischemia could improve the prognosis of patients with stable CAD., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Systemic lupus erythematosus (SLE) is a prototypical autoimmune disease in which dysregulation of B cells has been recognized. Here, we searched for potential biomarkers of SLE using liquid chromatography-tandem mass spectrometry (LC-MS)., Methods: Lymph nodes from SLE patients and controls were analyzed by LC-MS. To validate the identified molecules, immunoblotting and immunohistochemistry were performed and B cells from SLE patients were analyzed by quantitative RT-PCR. B-cell subsets from NZB/W F1 mice, which exhibit autoimmune disease resembling human SLE, were analyzed by flow cytometry. Endoplasmic reticulum (ER) stress was induced by tunicamycin and the serum concentration of anti-dsDNA antibodies was determined by ELISA. TUNEL methods and immunoblotting were used to assess the effect of tunicamycin., Results: MZB1, which comprises part of a B-cell-specific ER chaperone complex and is a key player in antibody secretion, was one of the differentially expressed proteins identified by LC-MS and confirmed by immunoblotting. Immunohistochemically, larger numbers of MZB1 + cells were located mainly in interfollicular areas and scattered in germinal centers in specimens from SLE patients compared with those from controls. MZB1 colocalized with CD138 + plasma cells and IRTA1 + marginal zone B cells. MZB1 mRNA was increased by 2.1-fold in B cells of SLE patients with active disease (SLE Disease Activity Index 2000 ≥ 6) compared with controls. In aged NZB/W F1 mice, splenic marginal zone B cells and plasma cells showed elevated MZB1 levels. Tunicamycin induced apoptosis of MZB1 + cells in target organs, resulting in decreased serum anti-dsDNA antibody levels. Additionally, MZB1 + cells were increased in synovial tissue specimens from patients with rheumatoid arthritis., Conclusions: MZB1 may be a potential therapeutic target in excessive antibody-secreting cells in SLE.

Because it suppresses attenuation artifacts from the diaphragm, prone SPECT is suitable for evaluating the cardiac inferior wall. A solid-state dedicated cardiac camera allows upright imaging, which can also be used to avoid attenuation artifacts from the diaphragm. We compared prone and upright imaging for inferior wall evaluation using 201 TlCl myocardial perfusion SPECT (MPS). Methods: The study targeted 45 patients. The prone imaging group included 23 subjects who underwent additional prone imaging because supine imaging indicated that the inferior wall had reduced uptake. The upright imaging group included 22 subjects who, in the past, had shown reduced uptake in the inferior wall during supine imaging. Using the MPS stress images and analysis software, we created a polar map showing the incorporation of the radioisotope throughout the whole of the myocardium; this polar map was then classified into 17 segments. The percentage uptake ratios of the inferior/anterior wall were calculated for the prone and upright acquisitions. These ratios were used as the ratio of percentage uptake in each segment of the anterior wall to percentage uptake in each segment of the inferior wall. In addition, 6 reviewers visually evaluated the uniformity within the inferior wall for both the prone and the upright imaging. Results: There was a significant difference in percentage uptake ratios between the prone and upright images in segments 4/1 (basal inferior/basal anterior; P < 0.05), 11/12 (mid inferolateral/mid anterolateral; P < 0.001), and 15/13 (apical inferior/apical anterior; P < 0.05). There were no significant differences between the prone and upright images in visual evaluations of uniformity within the inferior wall. Conclusion: In comparison with upright imaging, prone imaging has a higher rate of suppression of attenuation artifacts from the diaphragm. However, this difference does not seem to affect the images visually. Therefore, upright and prone imaging can be used interchangeably to evaluate the inferior wall., (© 2017 by the Society of Nuclear Medicine and Molecular Imaging.)

Purpose: Artificial neural networks (ANN) might help to diagnose coronary artery disease. This study aimed to determine whether the diagnostic accuracy of an ANN-based diagnostic system and conventional quantitation are comparable., Methods: The ANN was trained to classify potentially abnormal areas as true or false based on the nuclear cardiology expert interpretation of 1001 gated stress/rest 99m Tc-MIBI images at 12 hospitals. The diagnostic accuracy of the ANN was compared with 364 expert interpretations that served as the gold standard of abnormality for the validation study. Conventional summed stress/rest/difference scores (SSS/SRS/SDS) were calculated and compared with receiver operating characteristics (ROC) analysis., Results: The ANN generated a better area under the ROC curves (AUC) than SSS (0.92 vs. 0.82, p < 0.0001), indicating better identification of stress defects. The ANN also generated a better AUC than SDS (0.90 vs. 0.75, p < 0.0001) for stress-induced ischemia. The AUC for patients with old myocardial infarction based on rest defects was 0.97 (0.91 for SRS, p = 0.0061), and that for patients with and without a history of revascularization based on stress defects was 0.94 and 0.90 (p = 0.0055 and p < 0.0001 vs. SSS, respectively). The SSS/SRS/SDS steeply increased when ANN values (probability of abnormality) were >0.80., Conclusion: The ANN was diagnostically accurate in various clinical settings, including that of patients with previous myocardial infarction and coronary revascularization. The ANN could help to diagnose coronary artery disease.

Transgelin-2 (TAGLN2) is an actin-binding protein that controls actin stability and promotes T cell activation. TAGLN2 is also expressed on B-cells but its function in B-cells is unknown. We found that TAGLN2-expressing B-cells were localized in the germinal center (GC) of secondary lymphoid tissues and TAGLN2 mRNA was significantly upregulated after IgM+IgG stimulation in primary human B-cells, suggesting that TAGLN2 was upregulated upon B-cell activation. In support of this, lymph nodes (LNs) from patients with systemic lupus erythematosus (SLE), in which the intense GC activity have been recognized, showed increased TAGLN2 expression in B-cells compared to control LNs. Moreover, TAGLN2+B-cells were distributed widely not only in the GC but also in the perifollicular areas in SLE LNs. In contrast, CD19+ B-cells and CD19+CD27+ memory-B cells in peripheral blood of SLE patients showed no increase in TAGLN2 mRNA. Two-photon excitation microscopy of Raji cells demonstrated that TAGLN2 colocalized with F-actin and moved together to the periphery upon stimulation. TAGLN2-knockdown in Raji cells resulted in impaired phosphorylation of PLCγ2 leading to inhibition of cell migration. Microarray analysis of TAGLN2-knockdown Raji cells showed decreased expression of the genes associated with immune function including CCR6 and as well as of those associated with regulation of the actin cytoskeleton including ABI2, compared to controls. These results suggest that TAGLN2 might regulate activation and migration of B-cells, in particular, the entry of activated B-cells into the follicle. We also suggest that TAGLN2 could be used as a marker for activated B-cells.

Objective: Myocardial perfusion single-photon emission computed tomography (SPECT) is occasionally suspected to generate images that represent either ischemia or infarction for the inferior wall [right coronary artery (RCA) disease] or attenuation artifacts because of the diaphragm. We often encounter this. The application of prone imaging is advantageous in the differentiation of RCA disease because of attenuation artifacts. If decreased accumulation of radioisotopes is observed at the site with either RCA disease or attenuation artifacts, then a criterion that enables the addition of prone imaging should be implemented. Then, we evaluated sites where RCA disease and attenuation artifacts would likely appear and investigated the threshold of decreased accumulation that enables utilization of prone imaging., Patients and Methods: The patients in this study were divided into two groups: group A (20 patients) suspected to have attenuation artifacts because of the diaphragm and group B (14 patients) with RCA disease. Additional evaluation by prone imaging was performed in all patients. We utilized a 20-segment quantitative perfusion SPECT polar map in the supine and prone positions to compare the percentage increase in Thallium chloride (Tl) in both groups. We then investigated the percent uptake (%uptake) value of decreased accumulation in the inferior wall for the addition of prone imaging., Results: The highest %uptake was present in segments 3, 4, 5, and 10 in group A after the prone imaging. Detection of attenuation artifacts from the diaphragm was easy in segments 3, 4, 5, and 10, and we set the %uptake threshold at 62, 61, 71, and 76%, respectively, in the supine position for the addition of prone imaging., Conclusion: A decrease of the %uptake in segments 3, 4, 5, and 10 after supine imaging is presumed to result from attenuation artifact or RCA disease. We established evaluation criteria for the addition of prone imaging in patients with decreased accumulation in the inferior wall during supine imaging.

Aims: The prognostic impact of chronic total coronary occlusion (CTO) on implantable cardioverter-defibrillator (ICD) recipients remains unclear., Methods and Results: Eighty-four consecutive patients with ischaemic heart disease who received ICD therapy for primary or secondary prevention were analysed. We investigated all-cause mortality and major adverse cardiac events (MACEs) including cardiac death, appropriate device therapy, hospitalization for heart failure, and ventricular assist device implantation. Of the study patients (mean age 70 ± 8 years; 86% men), 34 (40%) had CTO. There were no significant differences in age, left ventricular ejection fraction (LVEF), New York Heart Association functional class III or IV status, and proportion who underwent secondary prevention between patients with CTO (CTO group) and without CTO (non-CTO group). During a median follow-up of 3.8 years (interquartile range 2.7-5.4 years), the CTO group tended to have a higher MACE rate (log-rank P = 0.054) than the non-CTO group. Within the CTO group, there was no difference in the MACE rate between patients with and without viable myocardium. In patients with ICD for secondary prevention (n = 47), 16 patients (34%) with CTO had a higher MACE rate than patients without CTO (log-rank P < 0.01). Cox proportional hazards regression analysis showed that the presence of CTO, but not LVEF, was associated with a higher MACE rate. Multivariate analysis showed that the presence of CTO was a predictor of MACE (P < 0.05)., Conclusion: In patients with ischaemic heart disease receiving ICD implantation, the presence of CTO has an adverse impact on long-term prognosis, especially as secondary prevention., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Objective: Cadmium-zinc-telluride detectors enable shorter acquisition durations in myocardial perfusion imaging (MPI), but the time interval of sequential scanning is still unchanged in clinical practice. We designed a very rapid 1-day protocol of MPI using cadmium-zinc-telluride single-photon emission tomography and evaluated the optimal dose ratio between two scanning acquisitions by means of simulations and phantom experiments., Methods: We intended to perform a 1-day MPI within 140 min and simulate radioactivities in the second scan under various injected dose ratios. To apply this, a cardiac phantom was scanned with various radioactivities and scans were compared with a reference scan with the ideal tracer concentrations., Results: In the stress-first protocol, the dose ratio 1 : 5 was enough to show the same regional percentage uptake compared with the reference. However, in the rest-first protocol, the regional percentage uptakes were higher than those of the reference image even with a 1 : 6 dose ratio., Conclusion: The injected dose ratio 1 : 5 is optimal in a stress-first rapid 1-day protocol. The rest-first protocol is not appropriate because a dose ratio greater than 1 : 6 is required to withdraw shine-through artifacts.

Background: Information received subconsciously can influence exercise performance; however, it remains unclear whether subliminal or supraliminal reward is more effective in improving standing balance ability when priming stimuli are subconsciously delivered. The present study aimed to compare the effects of subliminal priming-plus-subliminal reward stimuli (experimental) with subliminal priming-plus-supraliminal reward stimuli (control) on standing balance ability., Methods: This was a single-blind (outcome assessor), parallel-group, randomized controlled trial involving healthy young adults recruited from a university in Japan. Assessments were conducted at baseline and immediately after intervention. The primary outcome was the functional reach test (FRT) measurement. The secondary outcome was one-leg standing time (OLST) with eyes closed. Of the 52 participants screened, 25 were randomly assigned to experimental and control groups each., Results: Both interventions were effective for improving the FRT between the baseline and intervention; however, smaller improvements were observed in the experimental group. We found a large between-groups effect size immediately after the intervention for the FRT (d = -0.92). In contrast, there were no differences in improvements in OLST between the 2 groups (d = -0.06); furthermore, neither intervention was found to be effective for this parameter., Conclusion: We concluded that subliminal priming with conscious reward stimuli results in improvements in immediate-term forward reach ability, which is superior to that achieved by subliminal priming with subconscious reward stimuli.

Purpose: Left ventricular (LV) phase dyssynchrony parameters based on gated myocardial perfusion imaging varied among software programs. The aim of this study was to determine normal ranges and factors affecting phase parameters., Methods: Normal databases were derived from the Japanese Society of Nuclear Medicine working group (n = 69). The programs were Emory Cardiac Toolbox with SyncTool (ECTb), Quantitative Gated SPECT (QGS), Heart Function View (HFV), and cardioREPO (cREPO); parameters of phase standard deviation (PSD), 95% bandwidth, and entropy were compared with parameters with ECTb as a reference., Results: PSD (degree) was 5.3 ± 3.3 for QGS (P < .0001), 5.4 ± 2.5 for HFV (P < .0001), and 10.3 ± 3.2 for cREPO (P = n. s.) compared with 11.5 ± 5.5 for ECTb. Phase bandwidth with three programs differed significantly from ECTb. Gender differences were significant for all programs, indicating larger variation in males. After adjustment of LV volumes between genders, the difference disappeared except for QGS. The phase parameters showed wider variations in patients with the lower ejection fraction (EF) and larger LV volumes, depending on software types., Conclusion: Based on normal ranges of phase dyssynchrony parameters in four software programs, dependency on genders, LV volume, and EF should be considered, indicating the need for careful comparison among different software programs.

Objectives: Immunoglobulin G4-related disease (IgG4-RD) is a multiorgan condition manifesting itself in different forms. This study aimed to investigate protein expression profiles and to find the possible biomarker for IgG4-RD by liquid chromatography mass spectrometry (LC-MS) using tissue sections in IgG4-RD patients., Methods: Protein expression profiles in five IgG4-related pancreatitis and three normal pancreatic samples were compared using LC-MS and were validated by quantitative real-time PCR (qRT-PCR), immunoblotting, and immunohistochemistry. ELISA was employed in the serum of 20 patients with systemic IgG4-RD before and during steroid treatment., Results: LC-MS indicated that the levels of 17 proteins were significantly higher and 12 others were significantly lower in IgG4-related pancreatitis patients compared to controls. Among these proteins, galectin-3 levels were 13-fold higher in IgG4-related pancreatitis ( P < 0.01). These results were confirmed by immunoblotting and qRT-PCR. The average number of galectin-3 + cells in various organs of IgG4-RD patients, including salivary glands, lungs, and lymph nodes, was higher than in controls. Galectin-3 was detectable in macrophages, dendritic cells, and stromal myofibroblast-like cells, but not in lymphocytes by immunofluorescence staining. Serum galectin-3 levels were higher in patients with IgG4-RD compared with healthy donors and remained high during steroid therapy., Conclusion: Galectin-3 was overexpressed in IgG4-RD and the levels were indirectly related to clinical activity.

Background: Mobile technology to support community health has surged in popularity, yet few studies have systematically examined usability of mobile platforms for this setting., Methods: We conducted a mixed-methods study of 14 community healthcare workers at a public healthcare clinic in São Paulo, Brazil. We held focus groups with community healthcare workers to elicit their ideas about a mobile health application and used this input to build a prototype app. A pre-use test survey was administered to all participants, who subsequently use-tested the app on three different devices (iPhone, iPad mini, iPad Air). Usability was assessed by objectively scored data entry errors and through a post-use focus group held to gather open-ended feedback on end-user satisfaction., Results: All of the participants were women, ranging from 18-64 years old. A large percentage (85.7%) of participants had at least a high school education. Internet (92.8%), computer (85.7%) and cell phone (71.4%) use rates were high. Data entry error rates were also high, particularly in free text fields, ranging from 92.3 to 100%. Error rates were comparable across device type. In a post-use focus group, participants reported that they found the app easy to use and felt that its design was consistent with their vision. The participants raised several concerns, including that they did not find filling out the forms in the app to be a useful task. They also were concerned about an app potentially creating more work for them and personal security issues related to carrying a mobile device in low-income areas., Conclusion: In a cohort of formally educated community healthcare workers with high levels of personal computer and cell phone use, we identified no technological barriers to adapting their existing work to a mobile device based system. Transferring current data entry work into a mobile platform, however, uncovered underlying dissatisfaction with some data entry tasks. This dissatisfaction may be a more significant barrier than the data entry errors our testing revealed. Our results highlight the fact that without a deep understanding of local process to optimize usability, technology-based solutions in health may fail. Developing such an understanding must be a central component in the design of any mHealth solution in global health.

As a 2-year project of the Japanese Society of Nuclear Medicine working group activity, normal myocardial imaging databases were accumulated and summarized. Stress-rest with gated and non-gated image sets were accumulated for myocardial perfusion imaging and could be used for perfusion defect scoring and normal left ventricular (LV) function analysis. For single-photon emission computed tomography (SPECT) with multi-focal collimator design, databases of supine and prone positions and computed tomography (CT)-based attenuation correction were created. The CT-based correction provided similar perfusion patterns between genders. In phase analysis of gated myocardial perfusion SPECT, a new approach for analyzing dyssynchrony, normal ranges of parameters for phase bandwidth, standard deviation and entropy were determined in four software programs. Although the results were not interchangeable, dependency on gender, ejection fraction and volumes were common characteristics of these parameters. Standardization of (123)I-MIBG sympathetic imaging was performed regarding heart-to-mediastinum ratio (HMR) using a calibration phantom method. The HMRs from any collimator types could be converted to the value with medium-energy comparable collimators. Appropriate quantification based on common normal databases and standard technology could play a pivotal role for clinical practice and researches.