論文

A 70-year-old man developed left anterior chest pain, and was admitted to our hospital. His cardiac function was reduced (ejection fraction was 33%) because of old myocardial infarction. Chest X-ray, computed tomography (CT), and laboratory data revealed that he suffered from empyema and sepsis, and culture of blood and pleural fluid was positive for anaerobic bacteria. In spite of the therapy with intravenous antibiotics, his respiration status was deteriorated, and a drainage tube was inserted into his thoracic cavity. Soon after the operation, ventricular fibrillation occurred, and defibrillation, intubation and mechanical ventilation were required. Findings of Chest X-ray and CT were consistent with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The administration of sivelestat sodium hydrate (Elaspol), a neutrophil elastase inhibitor, along with antibiotics remarkably improved clinical condition (PaO2/FIO2 : 54.3 → 138) and became asepticaemic, although mechanical ventilation remained necessary because of the continued pulmonary congestion due to cardiac failure. During a month after treatment with sivelestat, respiratory and heart failure gradually improved and he was extubated. Indeed, he felt no dyspnea and could be discharged from hospital. Sepsis and systemic inflammatory response syndrome are known to cause life-threatening ALI/ARDS. Our case suggests that strategies for preventing and treating ALI/ARDS should include the administration of neutrophil elastase inhibitor at the early stage of the disease before irreversible alveolar damage may become predominant.

Patients with diastolic heart failure tend to have a poor outcome, similar to that for patients with systolic heart failure. The aim of this study was to explore the ability of MDCT to estimate the left ventricular diastolic function. Thirty patients with suspected coronary artery disease underwent MDCT and echocardiography. The early transmitral flow velocities (E) and the velocity of mitral annulus early diastolic motion (e') were measured in order to evaluate the diastolic function. The scanning delay of CT was determined using a test injection technique. The aortic enhancement was measured over the aortic-root lumen, and it was plotted over time to yield a time-enhancement-curve. A gamma variate function was then fit to the time-enhancement-curve and thereafter both the 'slope' of enhancement for each patient and the region of interest [ROI] were calculated. According to a univariate analysis, the slope of the time-enhancement-curve was found to correlate with the e' (r = 0.686, P = 0.000) and E/e' (r = -0.482, P = 0.007), however, no significant correlation was observed with the systolic parameters of the left ventricle. These results indicate that the slope of the time-enhancement-curve in the aorta significantly correlates with e', i.e. the diastolic parameters, which are independent of the systolic parameters. Based on these findings, we propose that the slope of the time-enhancement-curve may serve as a parameter for the left ventricular diastolic function on MDCT. © 2010 Elsevier Ireland Ltd. All rights reserved.

© 2016 Elsevier Ireland Ltd Background and aims Elevated fibroblast growth factor 23 (FGF23) levels are associated with cardiovascular mortality in patients with chronic kidney disease. However, both clinical and basic research have demonstrated conflicting evidence regarding the pathophysiological role of FGF23 in vascular calcification. The aim of this study was to determine the role of FGF23 in the osteoblastic gene expression in vascular smooth muscle cells (SMCs). Methods and results We transduce human aortic SMCs (HASMCs) expressing klotho and FGF receptors with the adenovirus expressing human FGF23 (Ad-FGF23). We observed significant decreases in the expression of osteoblast-marker genes including BMP2, BMP4, MSX2, RUNX2 and ALP, as well as reduced calcification. Notably, Ad-FGF23 increased mRNA and protein levels of osteoprotegerin (OPG), and human OPG promoter was activated by FGF23. Moreover, in HASMCs overexpressing klotho, FGF23 upregulated OPG expression, whereas depletion of klotho by siRNA attenuated FGF23-induced OPG expression. Furthermore, in 73 consecutive patients with type 2 diabetes mellitus undergoing cardiac computed tomography to determine coronary calcium scores (CCSs), serum FGF23 levels were positively correlated with OPG independent of phosphate and estimated glomerular filtration rate (eGFR, r = 0.65, p < 0.01). Serum FGF23 levels were significantly elevated in patients with high CCSs (≧100) compared to those with low CCSs (<100). Conclusions Our in vitro results indicate that FGF23 suppresses osteoblastic gene expression and induces OPG expression in HASMCs. Together with our cross-sectional clinical assessment, the present study lends support to our hypothesis that FGF23 counteracts osteogenic conversion of vascular SMCs as a part of a compensatory mechanism to mitigate vascular calcification.

We aimed to use upright computed tomography (CT) to depict posture-related changes in the brain tissue under normal gravity. Thirty-two asymptomatic volunteers underwent upright CT in the sitting position and conventional CT in the supine position on the same day. We compared the shift of the pineal body, cerebellar tonsil, the length of pituitary stalk, optic nerve sheath area and perimeter (ONSA and ONSP, respectively), and lateral ventricular volume between the supine and sitting positions. We also compared shape changes of the cerebrospinal fluid (CSF) spaces at different sites between both positions. In the sitting position, the pineal body shifted 0.68 ± 0.27 mm in the ventral direction and 0.76 ± 0.24 mm in the caudal direction, the length of pituitary stalk decreased by 1.23 ± 0.71 mm, the cerebellar tonsil descended by 2.10 ± 0.86 mm, the right ONSA decreased by 15.21 ± 6.54%, the left ONSA decreased by 15.30 ± 7.37%, the right ONSP decreased by 8.52 ± 3.91%, the left ONSP decreased by 8.20 ± 4.38%, and the lateral ventricular volume decreased by 5.07 ± 3.24% (all P < 0.001). We also observed changes in the shape of CSF spaces with changes in posture. We concluded that the intracranial structure of healthy subjects and volume of ventricles changed according to posture on Earth.

79歳女。歩いたところ、胸部圧迫感を自覚し、動けなくなった。ニトロ舌下を行ったが、すぐには改善せず、十数分たってから改善した。紹介受診した。心電図上、前胸部誘導でT波の陰転を認め、採血ではWBCは若干高値、LDLは高値であった。Cardiac CTでは、右冠状動脈末梢(#4AV)と左冠状動脈回旋枝(#11)に中等度狭窄病変(心筋虚血を起こしうる)を認めた。この所見は後日行われた冠動脈造影の所見と同様であった。薬物負荷心筋シンチでは側壁の虚血・下壁の欠損を認めた。また、Fasting PETでは側壁の虚血を認めた。左冠状動脈回旋枝の狭窄部より遠位領域に心筋虚血があり、他の領域には虚血が無いことが示された。CT上における冠状動脈の解剖学的情報とSPECT-PETにおける心筋の機能的情報を一元的に統合することができ、治療方針決定に有益であると考えられた。

© 2019 Background: Fluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis. Objectives: To determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancer patients. Methods: NaF positron emission tomography–computed tomography bone scans were evaluated in 437 prostate cancer patients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography–computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake. Results: Of 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range [IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94). Conclusions: NaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancer patients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established.

Background: The development of ultra-high–resolution CT (U-HRCT) is expected to improve the accuracy of coronary stenosis evaluation. This study aimed to evaluate the accuracy of the stenosis severities of coronary artery phantoms estimated using U-HRCT by comparing them to those estimated with conventional CT. Methods: Coronary artery phantoms with non-calcified and calcified lesions were scanned with conventional CT (64-row ​× ​0.625 ​mm) and U-HRCT (32-row ​× ​0.3125 ​mm). The coronary artery phantoms had lumen diameters of 2.0, 3.0, and 4.0 ​mm with non-calcified lesions representing 0%, 25%, 50%, and 75% stenosis and 3.0 and 4.0 ​mm with calcified lesions representing 0%, 25%, 50%, and 75% stenosis. The lumen diameters at the stenotic and non-stenotic regions were measured, and the stenosis severities were compared with the true values. Results: For non-calcified lesions, conventional CT significantly underestimated the stenosis severity in the phantom showing 75% stenosis with lumen diameters of 2.0 and 3.0 ​mm (p ​< ​0.05), while the estimated stenosis severities were not significantly different from the true values at all settings with U-HRCT. For the calcified lesions, conventional CT overestimated the stenosis severities at all settings (p ​< ​0.05), while U-HRCT yielded estimations closer to the true values, although still with some overestimation (p ​< ​0.05). Conclusion: By using U-HRCT, the estimated stenosis severities of the coronary artery with non-calcified lesion become almost equal to the true value, while those with calcified lesion are still overestimated although they become closer to the true value.