Parents' Needs and Satisfaction Levels for Parenting Support Schemes Provided by Local Government: Secondary Analysis of Cross-Sectional Survey Data.

We conducted a secondary analysis of the data derived from a cross-sectional survey among parents of school-age children in Japan. The present study explored variables associated with parents' satisfaction with the local parenting environment. Multivariable logistic regression was used by entering parental satisfaction as a dependent variable and basic and parenting-related items as independent variables. A total of 2218 respondents were stratified by self-determined financial circumstances. A higher proportion of respondents stated low satisfaction with the local parenting environment and support schemes among the financially struggling group (50.4%) than among the non-struggling group (33.8%). Among the financially struggling group, the variables significantly associated with low satisfaction were a lack of parenting support (adjusted odds ratio [aOR] = 1.612) and being unable to use after-school children's clubs (aOR = 1.747). Our exploratory analysis suggests that after-school children's clubs can be expected to play a role in widening social networks and community connectedness among parents struggling financially. This role should be reflected in municipal welfare policy.

Examination of 93 cases of perianal warts and suggestion of a new classification.

PURPOSE: The anatomical distribution of perianal warts is associated with patient characteristics such as sexual orientation. The purpose of this study is to confirm this experiential knowledge using a quantitative classification system and analysis and to obtain findings useful for future treatment. METHODS: From January 2014 to December 2020, 93 patients with perianal warts presented to our hospital. Patients were analyzed for age, sex, lesion site, and recurrence type, among other factors. The lesion site was divided into skin (S) and anal epithelium (anoderm, A), and the number and degree of each were classified into grades 0 to 3. The higher grade between S and A determines its dominant type, such as type S (e.g., S3A1) and type A (e.g., S0A2). RESULTS: The average age of the patients was 39.6 years, and the percentage of patients who were not married was 54.8%. In all, 95.8% of patients were positive for low-risk human papillomavirus (HPV). Type S accounted for 80.6%, whereas type A accounted for 9.7%. Type A cases were all male and were all presumed to be men who have sex with men (MSM). This indicates that the determination of type A may be highly specific for MSM. The type at the time of recurrence was the same type at the time of the first surgery in almost all cases. CONCLUSION: In cases of perianal warts, it is useful to analyze the lesion by considering the range and grade separately for daily clinical practice on proctologist.

Incidence of and improvement in inappropriate parental behaviors of mothers with young children: a retrospective cohort study conducted in collaboration with a local government.

BACKGROUND: Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors. METHODS: Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0. RESULTS: In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was "yelling at the child using emotional words" (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13-4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03). CONCLUSIONS: It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

Efficacy and safety of oral sulfate solution for bowel preparation in Japanese patients undergoing colonoscopy: Noninferiority-based, randomized, controlled study.

OBJECTIVES: To compare the efficacy and safety of oral sulfate solution administered using the same-day dose and the split-dose regimens with those of polyethylene glycol plus ascorbate solution, used for bowel preparation in Japanese patients undergoing colonoscopy. METHODS: This multicenter (n = 13), randomized, active-controlled, colonoscopist- and image evaluator-blinded, noninferiority study with parallel-group comparison recruited 632 patients from December 2018 to June 2019. Of these, 602 patients were divided into the oral sulfate solution same-day dose group (n = 200); oral sulfate solution split-dose group (n = 202); and polyethylene glycol plus ascorbate same-day dose group (n = 200). Differences in the efficacy rates between the polyethylene glycol plus ascorbate group and each oral sulfate solution group were calculated using the asymptotic method. The safety of the oral sulfate solution was evaluated, based on the occurrence of adverse events and reactions. RESULTS: Both oral sulfate solution protocols were confirmed as noninferior to the polyethylene glycol plus ascorbate protocol for bowel-cleansing. The occurrence of adverse reactions was significantly lower in the oral sulfate solution same-day dose group than in the polyethylene glycol plus ascorbate group (P = 0.010). The occurrence of adverse reactions was not significantly different between the oral sulfate solution split-dose and the polyethylene glycol plus ascorbate group. CONCLUSIONS: Oral sulfate solution is not only safe and efficacious but also not inferior to polyethylene glycol plus ascorbate solution (active control). It could be used for bowel preparation in Japanese patients scheduled for colonoscopy (Clinical trial registration number: NCT03794310).

[Coronary Computed Tomography Angiography for Patients with Atrial Fibrillation: Feasibility of Prospective Electrocardiography-gated Diastolic Acquisition with a Manual Exposure-termination Technique].

Coronary computed tomography angiography (CCTA) was performed in 283 patients with atrial fibrillation (Af) using a prospective electocardiogeaphic gated scanning with a manual exposure-termination technique. When preparatory 5-beat scanning contained at least one RR interval longer than 800 ms, 5-beat diastolic scanning (R+800 ms protocol) was selected. When no RR interval longer than 800 ms was observed, 2-beat scanning starting at end-systolic phase (R+210 ms to R protocol) was chosen. In R+800 ms protocol, we manually terminated scanning when motion free real-time reconstruction image was confirmed. R+800 ms protocol was applied in 95% of the cases and required an average of 2 cardiac cycles, providing motion-free images in 91% of the patients. The mean exposure dose was less than that with R+210 ms to R protocol. Using the protocols above, 90% of the all patients with Af provided motion free images and 99% of them were evaluable.

Pacemaker-induced Metallic Artifacts in Coronary Computed Tomography Angiography: Clinical Feasibility of Single Energy Metal Artifact Reduction Technique.

BACKGROUND: Coronary computed tomography angiography (CCTA) in patients with pacemaker suffers from metallic lead-induced artifacts, which often interfere with accurate assessment of coronary luminal stenosis. The purpose of this study was to assess a frequency of the lead-induced artifacts and artifact-suppression effect by the single energy metal artifact reduction (SEMAR) technique. METHODS: Forty-one patients with a dual-chamber pacemaker were evaluated using a 320 multi-detector row CT (MDCT). Among them, 22 patients with motion-free full data reconstruction images were the final candidates. Images with and without the SMEAR technique were subjectively compared, and the degree of metallic artifacts was compared. RESULTS: On images without SEMAR, severe metallic artifacts were often observed in the right coronary artery (#1, #2, #3) and distal anterior descending branch (#8). These artifacts were effectively suppressed by SEMAR, and the luminal accessibility was significantly improved in #3 and #8. CONCLUSION: While pacemaker leads often cause metallic-induced artifacts, SEMAR technique reduced the artifacts and significantly improved the accessibility of coronary lumen in #3 and #8.

2.4 g Mesalamine (Asacol 400 mg tablet) Once Daily is as Effective as Three Times Daily in Maintenance of Remission in Ulcerative Colitis: A Randomized, Noninferiority, Multi-center Trial.

BACKGROUND: The noninferiority of pH-dependent release mesalamine (Asacol) once daily (QD) to 3 times daily (TID) administration was investigated. METHODS: This was a phase 3, multicenter, randomized, double-blind, parallel-group, active-control study, with dynamic and stochastic allocation using central registration. Patients with ulcerative colitis in remission (a bloody stool score of 0, and an ulcerative colitis disease activity index of ≤2), received the study drug (Asacol 2.4 g/d) for 48 weeks. The primary efficacy endpoint of the nonrecurrence rate was assessed on the full analysis set. The noninferiority margin was 10%. RESULTS: Six hundred and four subjects were eligible and were allocated; 603 subjects received the study drug. The full analysis set comprised 602 subjects (QD: 301, TID: 301). Nonrecurrence rates were 88.4% in the QD and 89.6% in the TID. The difference between nonrecurrence rates was -1.3% (95% confidence interval: -6.2, 3.7), confirming noninferiority. No differences in the safety profile were observed between the two treatment groups. On post hoc analysis by integrating the QD and the TID, nonrecurrence rate with a mucosal appearance score of 0 at determination of eligibility was significantly higher than the score of 1. The mean compliance rates were 97.7% in the QD and 98.1% in the TID. CONCLUSIONS: QD dosing with Asacol is as effective and safe as TID for maintenance of remission in patients with ulcerative colitis. Additionally, this study indicated that maintaining a good mucosal state is the key for longer maintenance of remission.

[The Minimum Values of (RR-PQ) for High Quality Coronary CT Angiogram in Half, Automatic Patient's Motion Correction (APMC) and Full Reconstruction Using 320-ADCT (0.275 s/r)].

BACKGROUND: A clear coronary CT angiography (CCTA) can be obtained when temporal resolution (TR) is shorter than slow filling (SF) duration. The SF duration was calculated by the following equation: SF=-443+0.742 (RR-PQ). Although, the TR of half and full reconstruction using 320-ADCT (0.275 s/r) are known, the TR of automatic patient motion correction (APMC) reconstruction is not clear. The purpose of this study is to clarify the each minimum value of (RR-PQ) for acquiring a clear CCTA that was made by half, full or APMC reconstruction. METHOD: CCTA was performed in consecutive 345 (M/F=195/150, Age: 69±10 years) patients except for arrhythmia and the final heart rate (controlled by ß-blocker) ≥80 bpm using 320-ADCT (Aquilion ONE, 0.275 s/r). In all subjects, 3 CCTAs were generated by half, full, or APMC reconstruction at the same optimal phase. Image quality (A: excellent, B: acceptable, C: poor) was estimated by the consensus of three trained researchers. We classified (RR-PQ) into 15 groups by each 50 ms interval. RESULTS: The A or B % prediction (y) significantly correlated (y=-240.08+0.401x, r=0.98, p=0.0006 in half, y=-238.26+0.378x, r=0.98, p=0.0001 in APMC, and y=-236.84+0.332x, r=0.97, p<0.0001 in full reconstruction) with (RR-PQ) (x), respectively. CONCLUSION: The minimum values of (RR-PQ) for 95% prediction of A or B image quality were ≥836 ms in half, ≥881 ms in APMC, and ≥998 ms in full reconstruction.

Assessment of coronary in-stent restenosis: value of subtraction coronary computed tomography angiography.

In conventional coronary computed tomography angiography (CCTA), metal artifacts are frequently observed where stents are located, making it difficult to evaluate in-stent restenosis. This study was conducted to investigate whether subtraction CCTA can improve diagnostic accuracy in the evaluation of in-stent restenosis. Subtraction CCTA was performed using 320-row CT in 398 patients with previously placed stents who were able to hold their breath for 25 s and in whom mid-diastolic prospective one-beat scanning was possible. Among these patients, 126 patients (94 men and 32 women, age 74 ± 8 years) with 370 stents who also underwent invasive coronary angiography (ICA) were selected as the subjects of this study. With ICA findings considered the gold standard, conventional CCTA was compared against subtraction CCTA to determine whether subtraction can improve diagnostic accuracy in the evaluation of in-stent restenosis. When non-assessable stents were considered to be stenotic, the diagnostic accuracy in the evaluation of in-stent restenosis was 62.7 % for conventional CCTA and 89.5 % for subtraction CCTA. When the non-assessable stents were considered to be non-stenotic the diagnostic accuracy was 90.3 % for conventional CCTA and 94.31 % for subtraction CCTA. When subtraction CCTA was used to evaluate only the 138 stents that were judged to be non-assessable by conventional CCTA, 116 of these stents were judged to be assessable, and the findings for 109 of them agreed with those obtained by ICA. Even for stents with an internal diameter of 2.5-3 mm, the lumen can be evaluated in more than 80 % of patients. Subtraction CCTA provides significantly higher diagnostic accuracy than conventional CCTA in the evaluation of in-stent restenosis.

Subtraction coronary computed tomography in patients with severe calcification.

To investigate the clinical usefulness of subtraction coronary computed tomographic angiography (CCTA) in patients with severe calcification. A 320-row area detector CT system was used in this study. The subjects were 78 patients (47 men and 31 women, 739 years of age) with an Agatston score of >300 who were able to undergo prospective one-beat scanning during a single breath-hold. The CCTA findings were compared against invasive coronary angiography. The diagnostic capabilities of CCTA for the severely calcified segments with and without the additional information provided by subtraction CCTA were compared. Severe calcification was observed in 174 (31.9%) of the 546 segments, and non-assessable regions were observed in 74 (13.6%) of the segments. The addition of subtraction CCTA information improved the diagnostic accuracy for segments with severe calcification from 67.8 to 82.8% on a per-segment basis and from 70.1 to 82.1% on a per-patient basis, with non-assessable segments considered to be stenotic. When non-assessable segments were considered to be an incorrect diagnosis, the diagnostic accuracy was improved from 48.3 to 75.9% on a per-segment basis and from 43.3 to 79.1% on a per-patient basis. In addition, when evaluation was limited to non-assessable segments, subtraction CCTA provided a diagnostic accuracy of 81.1% when non-assessable segments were considered to be stenotic or 66.2% when non-assessable segments were considered to be an incorrect diagnosis. Subtraction CCTA improves the diagnostic capabilities of CCTA in patients with severe calcification.

[Clinical usefulness of low tube current scanning with full reconstruction and automatic patient motion correction (APMC) reconstruction in a prospective ECG-gated coronary CT angiography using 320-row area detector CT].

PURPOSE: The purpose of this study is to validate the clinical usefulness of Advanced Patient Motion Correction (APMC) reconstruction when motion artifacts were observed in a prospective ECG-gated coronary CT angiography (CCTA), which was acquired by low tube current scanning with full reconstruction using 320-row area detector CT (0.275 s/rot.). METHODS: Of 530 consecutive CCTA, we selected 119 patients (M/F: 71/48, Age: 69 ± 11 y, BMI: 23.5 ± 2.5) with (RR-PQ) ≥ 968 ms before scanning, and performed a CCTA with low tube current scanning [30% of usual tube current (30%mA)], adaptive iterative dose reduction 3D, and full reconstruction. Image quality for motion artifacts was subjectively evaluated using a 3-point scale (excellent, acceptable, and unacceptable). RESULTS: Of 119, 102 CCTA had "excellent" images (group A) and 17 had "acceptable" images (group B). The APMC and half reconstruction were retried in the 17 CCTA with "acceptable" images. Finally, all CCTA became "excellent" images. The RR-PQ of group B during scanning (966 ± 80 ms) was significantly (P = 0.0001) shorter than group A (1,088 ± 123 ms). Each image noise (standard deviation of CT value) of aorta, left atrium, and left ventricle was 21.7 ± 2.3, 24.7 ± 2.3, 24.5 ± 2.4 in full, 25.7 ± 2.2, 29.0 ± 3.4, 28.2 ± 2.7 in APMC, and 30.4 ± 2.8, 34.3 ± 4.2, 33.3 ± 2.9 HU in half reconstruction. Mean dose-length product of all patients was 66.2 ± 34.4 mGy · cm. CONCLUSION: "Excellent" CCTA images can be obtained in 85.7% of patients with (RR-PQ)≥ 968 ms by full reconstruction. APMC is useful for motion artifacts and image noise reduction when patient' s HR increases during scanning rather than half reconstruction.

Segmental distributions of calcifications and non-assessable lesions on coronary computed tomographic angiography: evaluation in symptomatic patients.

PURPOSE: To clarify the frequency and distribution pattern of calcifications in all and in only non-assessable coronary arterial segments in symptomatic patients with coronary heart disease. MATERIALS AND METHODS: Among 2355 consecutive coronary CT angiographies performed using a 320-row ADCT, 1129 studies performed by prospective one-beat scanning without metallic and motion artifacts were evaluated. Frequency and degree of calcification were assessed for each coronary segment. Evaluations were performed in all and in only non-assessable segments, and the results were compared. RESULTS: Calcified segments were observed in 15.6 % of patients and 2.4 % of segments. The most extensively calcified segments were those in the proximal left anterior descending branch. 1.1 % of all of the segments were not assessable due to calcification, and 90 % of those non-assessable segments had high-grade calcifications. When the calcium score value was 1000 or 2000, the expected frequency of non-assessable segments was 27.5 or 53.5 %, respectively. CONCLUSION: There were specific features of the distribution of coronary arterial calcifications. It is important to be familiar with these features when deciding whether or not to perform subtraction CCTA.

Overestimation of pretest probability of coronary artery disease by Duke clinical score in patients undergoing coronary CT angiography in a Japanese population.

BACKGROUND: The Duke clinical score (DCS) is commonly used to estimate the pretest probability of coronary artery disease (CAD). However, the criterion was developed in a population undergoing catheter angiography. OBJECTIVE: To test the hypothesis that DCS overestimates the CAD probability when applied to patients evaluated with coronary CT angiography (CCTA). A second objective is to compute an adjustment of the calculated DCS to apply to this population. METHODS: The DCS was calculated for the 3996 consecutive CCTA studies (February 2009 to April 2013) performed for symptomatic patients with no known CAD. Performance of the DCS for the detection of CAD was evaluated by the area under the receiver operating characteristic curve. Using the training cohort (n = 2789), a linear regression line between the calculated probability and the observed prevalence of CAD identified a modified DCS cutoff for a better risk categorization; this was internally validated by a separate cohort (n = 1207). RESULTS: The DCS showed a good discrimination (area under the receiver operating characteristic curve = 0.71) for the detection of CAD (prevalence = 23.3%). The calibration analysis showed an overall 2.4-fold overestimation by DCS with a DCS < 23% corresponding to the low-risk category (ie, observed prevalence of CAD < 10%). There was no appropriate DCS cutoff to define high-risk category (ie, prevalence > 90%). The validation cohort showed a prevalence of 9.4% when DCS < 23% was used to define low risk. CONCLUSION: Among patients who underwent CCTA, DCS overestimated the pretest probability by at least 2-fold; the DCS < 23% should define the lower risk probability. The DCS poorly identifies high-risk population and thus development of new CCTA-based criteria is warranted.

[Prospective electrocardiogram gated coronary 320-row area detector computed tomography angiography using low tube current scanning with full reconstruction].

BACKGROUND: It is possible to obtain equivalent image quality and a lower radiation dose using low tube current scanning with full reconstruction as compared to usual tube current scanning with half reconstruction in a 320-row area detector computed tomography (ADCT) angiography. METHOD: Of 589 patient underwent coronary CT angiography (CCTA), 11 patients with (RR-PQ) ≥1069 ms were enrolled. In those patients, low tube current (50% mA) scanning with full or half reconstruction were performed. As a control, 11 patients with matched pairs of tube voltage, BMI and heart rate who underwent usual scanning with half reconstruction (100% mA with half reconstruction) were selected. Standard deviation of the CT value (SD) was measured in aorta (Ao), left atrium (LA) and left ventricle (LV), and extended dose-length products (DLP.e) were calculated. RESULT: Significant motion artifact was not observed in any patients. SD of 50% mA with half reconstruction, 50% mA with full reconstruction, and 100% mA with half reconstruction were 28.1±2.6, 20.3±1.9, 20.7±2.5 HU in Ao, 34.4±4.4, 24.9±2.8, 24.9±3.1 HU in LA, and 29.7±2.3, 21.7±1.9, 22.1±2.3 HU in LV, respectively. There were not significant differences between 50% mA with full reconstruction and 100% mA with half reconstruction, but there were significant differences between 50% mA with half reconstruction and 50% mA with full reconstruction in all sites. The DLP.e of 50% mA scanning (74.1±21.8 mGy·cm) was significantly lower than 100% mA scanning (161.9±28.9 mGy·cm). CONCLUSION: CCTA with lower radiation dose and equivalent image quality can be obtained by ADCT using 50% mA scanning with full reconstruction in patients with (RR-PQ) ≥1069 ms.

[Comparison of the probability of meeting up with premature contraction during scanning in 320-area detector computed tomography with that in 64-multidetector CT coronary angiography].

BACKGROUND: Because coronary computed tomography angiography (CCTA) by 320-area detector CT (320-ADCT) can be obtained in a short time, the probability of meeting up with premature contraction (PC) during scanning may be lower in 320-ADCT compared to 64-MDCT. The purpose is to compare the probability of meeting up with PC, scanning time, and image quality in patients with PC between the 2 groups (320-ADCT vs 64-MDCT). METHODS: We have never rejected any CCTA examination due to arrhythmias. The 320-ADCT was performed in 2424 consecutive patients to include 70 atrial fibrillations (Afibs) and 64-MDCT in 1905 consecutive patients to include 51 Afibs. After exclusion of the patients with Afibs, we studied the probability of meeting up with PC during scanning and we compared the scanning time, image quality, and reconstruction phase for patients with PC between the 2 groups. RESULTS: The probability of meeting up with PC during scanning in 320-ADCT (2.0%) is significantly lower (P<0.0001) than 64-MDCT (5.6%). For patients with PC, scanning time in 320-ADCT (2.9±0.6 s) was significantly shorter (P<0.0001) than 64-MDCT (9.5±1.9 s) and image quality in 320-ADCT (2.9±0.3 points) was significantly higher (P<0.0001) than 64-MDCT (2.2±0.8 points). CCTA was reconstructed in mid-diastolic phase in 93% of patients with PC using the 320-ADCT with arrhythmia rejection system. CONCLUSION: The scanning time of 320-ADCT was 1/3 in comparison with that of 64-MDCT, and the probability of meeting up with PC during scanning in 320-ADCT was 1/3 in comparison with that in 64-MDCT.

The glomuvenous malformation protein Glomulin binds Rbx1 and regulates cullin RING ligase-mediated turnover of Fbw7.

Fbw7, a substrate receptor for Cul1-RING-ligase (CRL1), facilitates the ubiquitination and degradation of several proteins, including Cyclin E and c-Myc. In spite of much effort, the mechanisms underlying Fbw7 regulation are mostly unknown. Here, we show that Glomulin (Glmn), a protein found mutated in the vascular disorder glomuvenous malformation (GVM), binds directly to the RING domain of Rbx1 and inhibits its E3 ubiquitin ligase activity. Loss of Glmn in a variety of cells, tissues, and GVM lesions results in decreased levels of Fbw7 and increased levels of Cyclin E and c-Myc. The increased turnover of Fbw7 is dependent on CRL and proteasome activity, indicating that Glmn modulates the E3 activity of CRL1(Fbw7). These data reveal an unexpected functional connection between Glmn and Rbx1 and demonstrate that defective regulation of Fbw7 levels contributes to GVM.

[Reconstruction of coronary 64-multidetector-row computed tomography angiography in patients with atrial fibrillation: delete short RR intervals using electorocardiogram].

BACKGROUND: The image qualities of coronary 64-multidetector-row computed tomography angiography (CCTA) in patients with atrial fibrillation (Afib) are often not enough. This study clarifies how to use electrocardiogram (ECG) -editing in Afib. METHODS: We performed CCTA (Aquilion 64 with beam pitch: 0.125, 0.35 s/r) in 33 patients (M/F=24/9, age: 71±9 yr, mean heart rate: 71±12 bpm) with Afib. We injected 5 mg of verapamil into the vein when the mean HR was ≥80 bpm. First, we reconstructed images after deleting short RR (<800, 750, 700, 650, or 600). Second, we reconstructed images in 4 different methods: (1) end-systolic images with Phase Navi (automatically selecting an optimal phase) (ES-Navi), (2) Mid-diastolic images with Phase Navi (MD-Navi), (3) Mid-diastolic images reconstructed by the "R+absolute time method" [Edit-MD (R+)], and (4) Mid-diastolic images reconstructed by the "R-absolute time method" [Edit-MD (R-)]. We reconstructed 1 and 2 without ECG-editing, and 3 and 4 were reconstructed after ECG-editing without a data deficit. The quality of the images was classified into 3 ranks: no artifact (3), mild artifact (2), and severe artifact (1). RESULTS: The image quality point of CCTA, reconstructed after deleting RR<750, was similar to RR<800, and RR<750 was even higher than that after deleting HR<600, 650, or 700. The mean image quality point of CCTA that was reconstructed by Edit-MD (R-) or Edit-MD (R+) was significantly higher than ES-Navi or MD-Navi. CONCLUSION: The high image quality of CCTA could be reconstructed after deleting RR<750 in 76% or after deleting RR<800 in 70% of Afib. The reconstruction using Edit-MD (R-) or Edit-MD (R+) without a data deficit could provide a better quality CCTA than using PhaseNavi in Afib.

Prevalence of computed tomographic angiography-verified high-risk plaques and significant luminal stenosis in patients with zero coronary calcium score.

BACKGROUND: Some patients were detected with coronary artery disease even if the coronary artery calcium score was (CACS)=0. We evaluated the prevalence and predictor of significant stenosis and computed tomography (CT) based vulnerable plaque (CTVP) for patients with CACS=0. METHODS: Subjects were 2160 patients (M/F=1110/1050, 64.7 ± 11.6 years) who underwent measurement of calcium score and CT coronary angiography. As for CACS=0 group, age, gender, coronary risk factor (family history (FH), hypertension (HT), hyperlipidemia (HL), diabetes (DM), and smoking), body mass index, history of cerebral infarction, the presence of chest symptom, and abnormal rest ECG findings were investigated as predictors for significant stenosis and CTVP by multivariate analysis using logistic regression analysis. RESULTS: Out of 2160 patients, 1141 (52.8%, M/F=655/486, 68.4 ± 9.8 years) were of CACS>0 and 1019 (47.2%, M/F=455/564, 60.5 ± 12.0 years) were of CACS=0. In the CACS=0 group, 24 patients (2.4%) were found with significant stenosis and 47 (4.6%) with 2FPP. In 104 patients with spotty calcification (10.2%), 10 (9.6%) out of these 104 had significant stenosis and also had CTVP. Multivariate analysis using logistic regression analysis revealed significant predictor for significant stenosis to be only male (Odds ratio (OR): 3.075, 95%CI 1.166-8.109, p=0.0232) and significant predictor for CTVP to be age (OR: 1.032, 95%CI 1.001-1.063, p=0.0437) and male (OR: 2.386, 95%CI 1.193-4.775, p=0.0140). CONCLUSIONS: The present study suggests that the presence of CTVP must be noted, when patients are male and elderly even if CACS=0 and the presence of spotty calcification increases the prevalence of significant stenosis and CTVP in patients with CACS=0.

[Estimation of radiation dose and image quality of coronary 320-row area detector CT angiography by optimal prospective ECG-gated protocols for different heart rate].

The purpose of this study is to estimate radiation dose and image quality of ECG-gated coronary 320-area detector CT (ADCT) angiography which was acquired using the protocols that were considered as optimal methods for different heart rates (HR) in 1031 consecutive patients (M/F=580/451, 65 ± 12 yr) without arrhythmias. We set up 5 protocols for 320-ADCT based on the relationship among heart rates, temporal resolution, gantry rotation speed, optimal reconstruction phase and slow filling phase on 64-multidetector-row computed tomography (MDCT), ie, 1) mid-diastolic (75% of RR) 1 beat scan (MD 1 beat, N=761(73.8%)) for HR ≤ 60, 2) mid-diastolic (75% of RR) 2 beat scan (MD 2 beat, N=135) for 61 ≤ HR ≤ 65, 3) end-systolic and mid-diastolic (37-80% of RR) 2 beat scan (ES-MD 2 beat, N=92) for 66 ≤ HR ≤ 75, 4) end-systolic (R+280-430 ms) 2 beat scan (ES 2 beat, N=21) for 76 ≤ HR ≤ 80, and 5) end-systolic (R+250-400 ms) 3 beat scan (ES 3 beat, N=22) for 81 ≤ HR ≤ 105. Image quality was classified into 3 categories (excellent (3 points), acceptable (2 points), and unacceptable (1 point)). Scanning time, DLP.e and image quality score were 1.4 ± 0.1 s, 220 ± 59 mGy·cm, 3.0 ± 0.2 points in MD 1 beat, 2.2 ± 0.2 s, 434 ± 118 mGy·cm, 2.9 ± 0.3 points in MD 2 beat, 2.1 ± 0.2 s, 729 ± 229 mGy·cm, 2.7 ± 0.5 points in ES-MD 2 beat, 1.9 ± 0.1 s, 432 ± 148 mGy·cm, 2.2 ± 0.6 points in ES 2 beat, and 2.4 ± 0.2 s, 669 ± 152 mGy·cm, 2.3 ± 0.6 points in ES 3 beat respectively. In conclusion, the prospective ECG-gated scan protocol for coronary 320-ADCT angiography in any HR group was considered reasonable and proper for image quality and radiation dose.