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Purpose: To evaluate the feasibility of left atrial strain (LAS) assessment using cardiac computed tomography (CT) in patients with paroxysmal atrial fibrillation (PAF)., Methods: This retrospective single-center study included 98 patients with PAF who underwent cardiac CT and echocardiography before the first catheter ablation. LAS was analyzed using cardiac CT (CT-LAS) and speckle-tracking echocardiography (STE; STE-LAS). LA reservoir (LASr), conduit (LASc), and pump strain (LASp) were calculated by averaging LAS measured in 4- and 2-chamber views. The results were compared using Pearson's correlation coefficients, paired t-tests, and Bland-Altman analysis. Intraclass correlation coefficients (ICCs) were used to evaluate reproducibility., Results: CT-LAS could be analyzed in all patients, while STE-LAS could be analyzed in 53 (54%) patients. LASr, LASc, and LASp showed significant correlations between CT- and STE-LAS: LASr, r = 0.68, p < 0.001; LASc, r = 0.47, p < 0.001; LASp, r = 0.67, p < 0.001. LASr, LASc, and LASp of CT- and STE-LAS were 23.7 ± 6.0% and 22.1 ± 6.7%, 11.1 ± 3.6% and 11.1 ± 4.1%, and 12.6 ± 4.6% and 11.0 ± 4.1%, respectively. LASr and LASp were significantly higher in CT-LAS than that in STE-LAS (p = 0.023 for LASr and p = 0.001 for LASp). CT-LAS showed excellent reproducibility. The intra- and interobserver ICCs were 0.96 to 0.99 and 0.89 to 0.90, respectively., Conclusion: CT-LAS was successfully analyzed in more patients than STE-LAS and was highly reproducible. The findings suggest that CT-LAS is feasible for patients with PAF., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Coronary artery disease (CAD) is a common condition caused by the accumulation of atherosclerotic plaques. It can be classified into stable CAD or acute coronary syndrome. Coronary computed tomography angiography (CCTA) has a high negative predictive value and is used as the first examination for diagnosing stable CAD, particularly in patients at intermediate-to-high risk. CCTA is also adopted for diagnosing acute coronary syndrome, particularly in patients at low-to-intermediate risk. Myocardial ischemia does not always co-exist with coronary artery stenosis, and the positive predictive value of CCTA for myocardial ischemia is limited. However, CCTA has overcome this limitation with recent technological advancements such as CT perfusion and CT-fractional flow reserve. In addition, CCTA can be used to assess coronary artery plaques. Thus, the indications for CCTA have expanded, leading to an increased demand for radiologists. The CAD reporting and data system (CAD-RADS) 2.0 was recently proposed for standardizing CCTA reporting. This RADS evaluates and categorizes patients based on coronary artery stenosis and the overall amount of coronary artery plaque and links this to patient management. In this review, we aimed to review the major trials and guidelines for CCTA to understand its clinical role. Furthermore, we aimed to introduce the CAD-RADS 2.0 including the assessment of coronary artery stenosis, plaque, and other key findings, and highlight the steps for CCTA reporting. Finally, we aimed to present recent research trends including the perivascular fat attenuation index, artificial intelligence, and the advancements in CT technology., (© 2024. The Author(s).)

The nutrient intake of persons with diabetes placed on a low-carbohydrate diet remains unclear. This study aimed to assess nutrient intake in persons with type 2 diabetes mellitus treated with a low-carbohydrate diet. The brief-type self-administered diet history questionnaire was used to collect the dietary information of 335 outpatients at Kitasato Institute Hospital, while their clinical characteristics were collected from their electronic medical records. The median age, HbA1c level, and body mass index of the participants were 68 (60-74) years, 49 (45-55) mmol/mol [6.7 (6.3-7.2)%], and 24.0 (21.8-26.7) kg/m 2 , respectively; median energy intake was 1457 (1153-1786) kcal/day; and protein-energy, fat-energy, and available carbohydrate-energy ratios were 18.6 (15.7-21.4)%E, 36.8 (31.6-43.2)%E, and 34.6 (26.0-42.4)%E, respectively. As the available carbohydrate-energy ratio decreased, the fat-energy ratio increased significantly. The total dietary fibre and salt intake were 7.1 (5.6-8.4) g/1000 kcal and 6.5 (5.6-7.5) g/1000 kcal, respectively. Japanese individuals with type 2 diabetes mellitus placed on a low-carbohydrate diet had a fat-to-energy ratio exceeding 30%, while the fat-energy ratio increased as the carbohydrate-energy ratio decreased.

Background: Team-based learning (TBL) refers to the application of an active-learning method that has gained popularity across all health-care disciplines. This study aimed to assess nutrition students' perceptions of the roles of student versus faculty facilitators., Methods: Participants in the study included, 117 2nd-year nutrition students registered in the "Introduction to Medicine" course in the 2022 academic year at a Japanese university. The first TBL session was faculty-led, whereas three students served as facilitators in the second. Upon completion of the course, learners and student facilitators completed a questionnaire on the student-led TBL. Responses to close-ended questions were analyzed using descriptive statistics, and those to open-ended questions were categorized into common themes., Results: A total of 114 learners and 3 student facilitators responded to the questions. Learners found student-led TBL to be just as or more effective than faculty-led TBL in three respects: comprehension (93.0%), active participation (96.5%), and expectation of academic performance improvement (93.9%). According to student facilitators, it improved their knowledge, confidence, communication skills, and leadership abilities. Learners and facilitators indicated that student-led TBL was significantly more effective than faculty-led TBL. Thus, student-led TBL can enhance the ability of all students at different academic levels., Discussion: Student-led TBL appears to be an effective learning strategy in higher education and further shifts toward student-centered learning in the course curriculum., (Copyright © 2023 Copyright: © 2023 Education for Health.)

Background: Transcatheter aortic valve implantation (TAVI) has recently become more common as a treatment for severe, symptomatic aortic stenosis (AS). Cognitive impairment (CI) is strongly associated with the prognosis of TAVI patients. However, some cognitive assessments currently in use are difficult to perform routinely in the clinical setting. To easier CI evaluation, we investigated whether CI using the clock-drawing test (CDT), one part of the Mini-Cog, affects the postoperative prognosis of TAVI patients with AS., Methods: The present study enrolled 52 patients (median age, 85 years; 28.8% male) who underwent TAVI and were discharged between 2019 and 2021. The outcome was readmission for all causes within one year of discharge and patients were grouped according to whether they were readmitted or not. Cognitive function was assessed using the Mini-Cog which combines verbal playback and CDT., Results: Of the 52, 11 patients (21.2%) comprised readmission group, including 4 (36.4%) each for fracture and infection, and 1 (9.1%) each for heart failure, subdural hematoma, and pneumothorax. Median Mini-Cog score was lower in the readmission group than in the non-readmission group (4 vs. 5; P < 0.05). The frequency of Mini-Cog score < 3 (indicative of CI) and CDT failure were significantly higher in the readmission group than in the non-readmission group, respectively (46% vs. 7%, P < 0.01) (46% vs. 12%, P < 0.05). Both of Mini-Cog score < 3 and CDT failure were independently associated with readmission. The areas under the curve showed CDT was an indicator of readmission with similar accuracy to the Mini-Cog score < 3. Kaplan-Meier curves showed significant differences in readmission after 1 year between the 2 Mini-Cog groups with scores of < 3 or ≥ 3 points and CDT failure and success., Conclusion: The CDT may be a very easy and simple screening assessment of preoperative CI with readmission within one year after TAVI., Competing Interests: The authors declare no conflict of interest., (©2023 Tottori University Medical Press.)

Purpose: To evaluate left atrial (LA) function in patients with hypertrophic cardiomyopathy (HCM) by LA strain assessment using cardiac computed tomography (CT-derived LA strain)., Materials and Methods: This was a retrospective study of 34 patients with HCM and 31 non-HCM patients who underwent cardiac computed tomography (CT) using retrospective electrocardiogram-gated mode. CT images were reconstructed every 5% (0-95%) of the RR intervals. CT-derived LA strain (reservoir [LASr], conduit [LASc], and booster pump strain [LASp]) were semi-automatically analyzed using a dedicated workstation. We also measured the left atrial volume index (LAVI) and left ventricular longitudinal strain (LVLS) for the left atrial and ventricular functional parameters to assess the relationship with CT-derived LA strain., Results: CT-derived LA strain significantly correlated with LAVI: r = - 0.69, p < 0.001 for LASr; r = - 0.70, p < 0.001 for LASp; and r = - 0.35, p = 0.004 for LASc. CT-derived LA strain also significantly correlated with LVLS: r = - 0.62, p < 0.001 for LASr; r = - 0.67, p < 0.001 for LASc; and r = - 0.42, p = 0.013 for LASp. CT-derived LA strain in patients with HCM was significantly lower than that in non-HCM patients: LASr (20.8 ± 7.6 vs. 31.7 ± 6.1%, p < 0.001); LASc (7.9 ± 3.4 vs. 14.2 ± 5.3%, p < 0.001); and LASp (12.8 ± 5.7 vs. 17.6 ± 4.3%, p < 0.001). Additionally, CT-derived LA strain showed high reproducibility; inter-observer correlation coefficients were 0.94, 0.90, and 0.89 for LASr, LASc, and LASp, respectively., Conclusion: CT-derived LA strain is feasible for quantitative assessment of left atrial function in patients with HCM., (© 2023. The Author(s).)

Aim: To evaluate the usefulness of synthetic magnetic resonance imaging (MRI) performed before the initiation of neoadjuvant chemotherapy (NAC) in predicting whether breast cancers can achieve a pathological complete response (pCR) after the completion of NAC., Materials and Methods: This retrospective study investigated 37 consecutive patients with 39 breast cancers (pCR: 14, and non-pCR: 25) who underwent dynamic contrast-enhanced (DCE)-MRI and synthetic MRI before the initiation of NAC. Using synthetic MRI images, quantitative values (T1 and T2 relaxation times, proton density [PD] and their standard deviations [SD]) were obtained in breast lesions, before (Pre-T1, Pre-T2, Pre-PD, SD of Pre-T1, SD of Pre-T2, SD of Pre-PD) and after (Gd-T1, Gd-T2, Gd-PD, SD of Gd-T1, SD of Gd-T2, SD of Gd-PD) contrast agent injection. The aforementioned quantitative values and several morphological features that were identified on DCE-MRI were compared between pCR and non-pCR., Results: Multivariate analyses revealed that the SD of Pre-T2 (p=0.038) was significant and was an independent predictor of pCR, with an area under the receiver operating characteristics curve of 0.829. The sensitivity, specificity, and accuracy of the SD of Pre-T2 with an optimal cut-off value of 11.5 were 71.4%, 80%, and 76.3%, respectively., Conclusions: The SD of Pre-T2 obtained from synthetic MRI was used successfully to predict those breast cancers that would achieve a pCR after the completion of NAC; however, these results are preliminary and need to be verified by further studies., (Copyright © 2022 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

We evaluated the feasibility of myocardial perfusion ratio to the aorta (MPR) in static computed tomography perfusion (CTP) for detecting myocardial perfusion abnormalities assessed by single-photon emission computed tomography (SPECT). Twenty-five patients with suspected coronary artery disease who underwent dynamic CTP and SPECT were retrospectively evaluated. CTP images scanned at a sub-optimal phase for detecting myocardial perfusion abnormalities were selected from dynamic CTP images and used as static CTP images in the present study. The diagnostic accuracy of MPR derived from static CTP was compared to those of visual assessment and conventional quantitative parameters such as myocardial CT attenuation (HU) and transmural perfusion ratio (TPR). The area under the curve of MPR (0.84; 95% confidence interval [CI], 0.76−0.90) was significantly higher than those of myocardial CT attenuation (0.73; 95% CI, 0.65−0.79) and TPR (0.76; 95% CI, 0.67−0.83) (p < 0.05). Sensitivity and specificity were 67% (95% CI, 54−77%) and 90% (95% CI, 86−92%) for visual assessment, 51% (95% CI, 39−63%) and 86% (95% CI, 82−89%) for myocardial CT attenuation, 63% (95% CI, 51−74%) and 84% (95% CI, 80−88%) for TPR, and 78% (95% CI, 66−86%) and 84% (95% CI, 80−88%) for MPR, respectively. MPR showed higher diagnostic accuracy for detecting myocardial perfusion abnormality compared with myocardial CT attenuation and TPR.

X-ray diffraction measurements are performed on a 1 m (= mol kg -1 ) CeCl 3 aqueous solution over a temperature range of 300-600 K and a pressure range of 0.1 MPa to 4 GPa. The experimental interference functions are analyzed by an empirical potential structure refinement (EPSR) modeling. The Ce 3+ coordinates water molecules in a tricapped trigonal prism configuration under the ambient condition. The number of water molecules around Ce 3+ changes from 8.8 at 0.1 MPa/300 K to 11.5 at 4 GPa/600 K. The number of water molecules around Cl - changes drastically from 10 under the ambient condition to 17 at 4 GPa/600 K. The tetrahedral-like network structure of water under the ambient condition is transformed toward a simple liquid-like packing in the GPa pressure range. The corresponding coordination number is increased from 4.3 in the ambient condition to 9.7 at 4 GPa/600 K. The Ce 3+ -Cl - association decreases with increasing pressure., (© 2022. The Author(s), under exclusive licence to The Japan Society for Analytical Chemistry.)

Background: This study evaluated corrected relative flow reserve (RFR) derived from 13 N-ammonia positron emission tomography (PET) combined with coronary computed tomography angiography (CTA)., Methods: We analyzed 61 patients who underwent coronary CTA, 13 N-ammonia PET, and invasive coronary angiography. Triple-vessel disease were excluded. Conventional RFRs were calculated as the ratio of hyperemic myocardial blood flow (hMBF) of hypoperfusion areas to those of non-ischemic lesions. Corrected RFRs were calculated using PET and coronary CTA to adjust coronary territories to their feeding vessels. Diagnostic performance was compared to detect obstructive coronary lesions., Results: Of the 180 vessels analyzed, 50 were diagnosed as obstructive lesions (≥ 70% stenosis and/or fractional flow reserve value ≤ 0.8). The coronary flow reserve (CFR), hMBF, conventional RFR, and corrected RFR of obstructive lesions were significantly lower than those of non-obstructive lesions. In receiver operating characteristic curve analysis, these quantitative PET measurements had area under the curve of 0.67, 0.71, 0.89, and 0.92, respectively. Diagnostic performance differences between corrected and conventional RFR were not statistically significant., Conclusion: In patients with single or double vessel disease, indices of RFR, with or without coronary angiographic guidance of the reference coronary territory, are better discriminators of flow-limiting stenoses than hMBF and CFR., (© 2019. American Society of Nuclear Cardiology.)

The structure of a 3 m (= mol/kg) NaCl aqueous solution at 1.3 and 1.7 GPa and 300 K, as well as at an ambient condition, is determined by synchrotron X-ray diffraction measurements combined with an empirical potential structure refinement (EPSR) modeling. When the solution is pressurized to the gigapascal pressure range, the ice-like hydrogen-bonded water network at 300 K/0.1 MPa is drastically perturbed to give rise to a simple, liquid-like water molecules arrangement retaining the hydrogen bonds. The coordination number of the chloride ion increases from around 6 at 0.1 MPa to about 16 at 1.7 GPa, accompanied by the extended solvation shells' evolution. On the other hand, the sodium ion's solvation structure does not change significantly with pressure and consists of 6-fold water molecules' coordination. We discuss a structure makers/breakers' concept for the ion solvation concerning the water structure in the gigapascal pressure range.

Background: This study evaluated the diagnostic capability of on-site coronary computed tomography-derived computational fractional flow reserve (CT-FFR) determinations for detecting coronary artery disease (CAD), as assessed by invasive fractional flow reserve (FFR)., Methods and results: Seventy-four patients with coronary artery calcium scores <1,500 who underwent coronary CT angiography (CTA) and invasive FFR measurements within 90 days were retrospectively reviewed. CT-FFR was computed using a prototype machine-learning (ML) algorithm in 91 vessels; 47 vessels of 42 patients were determined to have significant CAD (FFR ≤0.8). Correlation between CT-FFR and FFR was good (r=0.786, P<0.001). Per-vessel area under the curve was significantly larger for CT-FFR (0.907, 95% confidence interval: 0.828-0.958) than for CTA stenosis ≥50% (0.595, 0.487-0.697) or ≥70% (0.603, 0.495-0.705) (both P<0.001). Standard coronary CTA classifications recommended further functional tests in 57 patients with moderate or worse stenosis on CTA. CT-FFR analysis (mean analysis time: 16.4±7.5 min) corrected the standard coronary CTA classification in 18 of 74 patients and confirmed it in 45 of 74 patients. Thus, the per-patient diagnostic accuracy of the classifications was improved from 66% (54-77%) to 85% (75-92%)., Conclusions: On-site CT-FFR based on a ML algorithm can provide good diagnostic performance for detecting hemodynamically significant CAD, suggesting the high value of coronary CTA for selected patients in clinical practice.

Conventional angiography is insufficient for evaluating the therapeutic effect of cardiac regeneration therapy. A microangiographic X-ray system using a cerium anode was developed. Cerium has a characteristic X-ray with a peak at 34.6 keV, which allows visualization of tiny amounts of iodine. The performance of the cerium anode X-ray system was evaluated in two excised normal canine hearts and in excised ischemic canine hearts treated with c-kit-positive cardiac stem cells (5 canines) or without cells (5 control canines). In the normal canines, branches penetrating from the left anterior descending artery into the myocardium were visualized, down to third-order branches. In just the treated hearts treated with stem cells, small vessels characterized by irregular vessel walls were observed. The cerium anode X-ray system allowed visualization of microvessels in excised ischemic canine hearts, and may evaluate the effect of cardiac stem cell therapy.

To assess a two-phase contrast injection protocol for contrast enhancement during cardiac computed tomography (CT) in children with congenital heart disease. Forty-three children (20 boys, 23 girls) of median age 13 months (range 3 days-8.3 years) and weighing ≤ 20 kg who underwent cardiac CT using a two-phase contrast injection protocol at our institution were retrospectively identified. High-pitch spiral third-generation dual-source cardiac CT (tube voltage 70 kV) was performed with a fixed delay of 60 s after contrast injection in the order of 10 mgI/kg/s (30 s), 15 mgI/kg/s (20 s), and a saline chaser (10 s). Attenuation in the inferior vena cava (IVC), superior vena cava (SVC), right atrium (RA), right ventricle (RV), pulmonary artery (PA), left atrium (LA), left ventricle (LV), and descending aorta (AO) was compared using the Steel-Dwass and Fisher's exact tests. The median (interquartile range) attenuation in the IVC, SVC, RA, RV, PA, LA, LV, and AO was 285 (264-347) Hounsfield units (HU), 416 (370-445) HU, 368 (320-388) HU, 373 (322-417) HU, 397 (330-432) HU, 425 (373-469) HU, 435 (385-468) HU, and 437 (392-491) HU, respectively (p < 0.05, IVC vs. the other anatomic sites). There was no significant difference in diagnostic success rate for attenuation > 250 HU between the IVC (41 children, 95.3%) and the other sites (43 children, 100%). A two-phase contrast injection protocol is useful for effective contrast enhancement in pediatric cardiac CT.

Objective: To evaluate the feasibility of image subtraction in late iodine enhancement CT (LIE-CT) for assessment of myocardial infarction (MI)., Methods: A comprehensive cardiac CT protocol and late gadolinium enhancement MRI (LGE-MRI) was used to assess coronary artery disease in 27 patients. LIE-CT was performed after stress CT perfusion (CTP) and CT angiography. Subtraction LIE-CT was created by subtracting the mask volume of the left ventricle (LV) cavity from the original LIE-CT using CTP dataset. The %MI volume was quantified as the ratio of LIE to entire LV volume, and transmural extent (TME) of LIE was classified as 0%, 1-24%, 25-49%, 50-74% or 75-100%. These results were compared with LGE-MRI using the Spearman rank test, Bland-Altman method and chi-square test., Results: One hundred twenty-five (29%) of 432 segments were positive on LGE-MRI. Correlation coefficients for original and subtraction LIE-CT to LGE-MRI were 0.79 and 0.85 for %MI volume. Concordances of the 5-point grading scale between original and subtraction LIE-CT with LGE-MRI were 75% and 84% for TME; concordance was significantly improved using the subtraction technique (p <0.05)., Conclusion: Subtraction LIE-CT allowed more accurate assessment of MI extent than the original LIE-CT., Key Points: • Subtraction LIE-CT allows for accurate assessment of the extent of myocardial infarction. • Subtraction LIE-CT shows a close correlation with LGE-MRI in %MI volume. • Subtraction LIE-CT has significantly higher concordance with TME assessment than original LIE-CT.

Background: This study aimed to evaluate the feasibility of peak enhancement (PE) ratio of myocardium to aorta (PER) derived from stress dynamic computed tomography myocardial perfusion imaging (CTP) for the detection of myocardial ischemia assessed by magnetic resonance (MR) imaging., Methods: Forty-four patients who underwent stress dynamic CTP and MR imaging were retrospectively evaluated. From the time-attenuation curve, myocardial PE, PER, and myocardial blood flow (MBF) were calculated on a segment-based analysis. The correlation between myocardial and aortic PE was assessed by Spearman's correlation, and the differences in myocardial PE and PER between normal and ischemic myocardium were assessed by the Mann-Whitney U-test. The diagnostic accuracies of myocardial PE, PER, and MBF for detecting myocardial ischemia were compared by receiver operating characteristic analysis., Results: Of 704 segments, 258 segments (37%) were diagnosed as myocardial ischemia with MR imaging. Myocardial and aortic PE were significantly correlated in both normal and ischemic segments (r=0.76 and 0.58; p<0.05, in each). The myocardial PE and PER of ischemic segments were significantly lower than those of normal segments (p<0.05, in each). Sensitivity and specificity were 61% [95% confidence interval (CI), 55-70%] and 83% (95% CI, 73-87%) for myocardial PE, 78% (67-88%) and 82% (95% CI, 70-91%) for PER, and 81% (95% CI, 73-87%) and 85% (95% CI, 79-92%) for MBF. There was a significantly larger area under the curve for PER (0.87; 95% CI, 0.84-0.90) and MBF (0.88; 95%CI, 0.85-0.91), compared to myocardial PE (0.75; 95% CI, 0.70-0.79) (p<0.05, in each). There was no significant difference in area under the curve between PER and MBF., Conclusions: The semi-quantitative parameter of PER showed a high diagnostic accuracy for the detection of myocardial ischemia, comparable to that of MBF., (Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

We evaluated the image quality and diagnostic performance of late iodine enhancement computed tomography (LIE-CT) with knowledge-based iterative model reconstruction (IMR) for the detection of myocardial infarction (MI) in comparison with late gadolinium enhancement magnetic resonance imaging (LGE-MRI). The study investigated 35 patients who underwent a comprehensive cardiac CT protocol and LGE-MRI for the assessment of coronary artery disease. The CT protocol consisted of stress dynamic myocardial CT perfusion, coronary CT angiography (CTA) and LIE-CT using 256-slice CT. LIE-CT scans were acquired 5 min after CTA without additional contrast medium and reconstructed with filtered back projection (FBP), a hybrid iterative reconstruction (HIR), and IMR. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were assessed. Sensitivity and specificity of LIE-CT for detecting MI were assessed according to the 16-segment model. Image quality scores, and diagnostic performance were compared among LIE-CT with FBP, HIR and IMR. Among the 35 patients, 139 of 560 segments showed MI in LGE-MRI. On LIE-CT with FBP, HIR, and IMR, the median SNRs were 2.1, 2.9, and 6.1; and the median CNRs were 1.7, 2.2, and 4.7, respectively. Sensitivity and specificity were 56 and 93% for FBP, 62 and 91% for HIR, and 80 and 91% for IMR. LIE-CT with IMR showed the highest image quality and sensitivity (p < 0.05). The use of IMR enables significant improvement of image quality and diagnostic performance of LIE-CT for detecting MI in comparison with FBP and HIR.

Background: The risk factors among the types of ischemic stroke (atherothrombotic cerebral infarction: ATI, cardio-embolic infarction: CEI, lacunar infarction: LI) in aged stroke patients have rarely been compared to each other., Methods: We compared the clinical parameters of 300 elderly patients with ischemic stroke, age 65-98years, to 100 age-matched control patients., Results: Comparison by parametric test and logistic regression analysis between all 300 and 100 control patients showed higher systolic and diastolic blood pressures (p<0.001, p=0.03), lower estimated glomerular filtration rate (eGFR) (p=0.01), larger cardiothoracic ratio (CTR) (p<0.001), smoking (p<0.01) and possibly poor adherence to anti-hypertensive agents in the ischemic stroke patients (p<0.001). Comparisons among three types (n=100 for each) showed the highest atheromatous risk factors for ATI to be hemoglobin A1c (p=0.01) and low-density lipoprotein (p<0.001) and for CEI to be largest cardiac load, indicated by largest left atrial dimension (p<0.001), and CTR (p<0.001). Triglyceride level was found to be a borderline risk factor for LI (p=0.054). Comparison between those aged <74 versus ≥75years (n=150 for each) showed a lower eGFR (p=0.02) and larger right atrial dimension (p<0.001) in patients ≥75., Conclusion: The risk factors were quite different among the subtypes and aging., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The purpose of the present study is to evaluate the vital prognoses of elderly people in their mid-eighties living in a group home (GH) compared to age- and sex-matched outpatient clinic (OPC) in an observational study conducted over 6 years. We investigated the association between mortality and general, cardiac, and nutritional parameters, including eicosapentaenoic acid (EPA) in 54 GH residents (83 ± 8 years old) and 57 OPC attendees (83 ± 5 years old). Kaplan-Meier curves and Cox proportional hazard ratio analyses were used to assess the association between EPA drug administration and mortality in the GH residents and OPC attendees, respectively. The 54 GH residents had higher mortality and poorer nutritional states, as indicated by lower EPA/arachidonic acid values (median 0.20 vs 0.55, p < 0.001), and BMI under the condition without EPA drug administration (1800 mg daily) than did the OPC group. The significant factors that differed between survivors and deceased in the GH residents and OPC attendees were nutritional and cardiac factors. Cox proportional hazard ratio analysis confirmed that a possible determinant of the prognosis was a lower incidence of EPA drug administration and lower hemoglobin in GH. Kaplan-Meier curves and Cox proportional hazard ratio analyses revealed that EPA drug administration significantly reduced the relative mortality by 82 % in the GH residents (p < 0.001) but not in the OPC attendees. The vital prognosis in individuals from GHs was potentially improved by EPA drug administration, which was not the case in the OPC group; however, further prospective studies are needed.

Objective: Lacunar stroke may be caused by infarction of small perforating branches of the middle cerebral artery. We developed a microangiographic X-ray system using a cerium anode to evaluate the perforating branches., Methods: Iodine has K-edges at 33.2 kilo electron volts. Cerium yields a characteristic X-ray of 34.6 kilo electron volts, therefore, the cerium anode X-ray system could detect tiny amounts of contrast material. First, an X-ray chart was used to evaluate the resolution. Second, the brains of mice were dissected and irradiated. Third, the brains of dogs were excluded and irradiated. Fourth, iodine was perfused into the carotid artery of living dogs during brain imaging., Results: In the first experiment, the cerium anode X-ray system elicited 4.86 clear line pairs. In mice, the perforating branches of the middle cerebral artery could be visualized. The perforating branches were clearly observed in dog brains ex situ even through an acrylic plate, but not in conventional X-ray images. Iodine moving inside the perforating branches was visualized in dog brains in situ using the cerium anode X-ray system., Conclusion: The cerium anode X-ray system allowed us to visualize the perforating branches of the middle cerebral artery in living dogs.

Cilostazol, a pluripotent phosphodiesterase III-specific inhibitor with anti-platelet and vasculogenic effects, is useful for preventing recurrent brain vascular events, particularly in stroke patients with diabetes mellitus (DM). However, it is unclear whether cilostazol affects autoregulatory responses in small cerebral arteries. Thus, we investigated the effect of cilostazol on diabetic brain vasculopathy in a model of type II DM using male OLETF rats. OLETF rats were treated with either cilostazol (CG) or vehicle (VG) and subjected to microangiography with monochromatic synchrotron radiation to investigate middle cerebral artery (MCA) vasoreactivity following an injection of acetylcholine (Ach). Ach administration led to MCA diameter contraction in the VG, but MCA dilation in the CG. We also evaluated morphological changes in the small intracranial vessels and found that in the CG, the endothelial cell structure in the small artery was not destroyed. Moreover, protein levels of phosphorylated endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) were higher in each evaluated brain region in CG rats vs. VG rats. Our results suggest that cilostazol could potentially improve autoregulatory responses in the small cerebral arteries by increasing eNOS phosphorylation and VEGF expression in DM, and thus, may act as a neurovascular protectant., (Copyright © 2016 Elsevier Ireland Ltd and Japan Neuroscience Society. All rights reserved.)

Background: Single-phase myocardial computed tomography perfusion (CTP) is useful for detecting myocardial ischemia, but determining the optimal scan time is difficult. The present study evaluated this by analyzing dynamic CTP data., Methods and results: We retrospectively selected 32 patients, all of whom had undergone stress dynamic CTP and magnetic resonance myocardial perfusion imaging (MR-MPI). Myocardial ischemia was assessed by MR-MPI using the 16-segment model. Whole-heart dynamic CTP data were acquired for 30 consecutive heartbeats without spatial or temporal gaps using a wide-detector CT, and redistributed into 11 series of single-phase CTP acquired from -2 s to 8 s from the time of maximal enhancement (Tmax) in the ascending aorta. Single-phase CTP images were visually assessed at the segment level, and diagnostic performance of single-phase CTP images for detecting myocardial ischemia was compared with dynamic CTP. Of 512 segments, 177 segments (35%) were diagnosed as ischemic by MR-MPI. The diagnostic accuracy of single-phase CTP acquired at 2-6 s from Tmax in the ascending aorta (median 86%, range 84-87%) was comparable to that of dynamic CTP., Conclusions: The optimal scan time for detecting myocardial ischemia with single-phase CTP was at 2-6 s from Tmax in the ascending aorta. (Circ J 2016; 80: 2506-2512).