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There is no recommended observation time for patients who have undergone radical prostatectomy for prostate cancer. This study was undertaken to determine the postoperative observation time by investigating the hazard rate for prostate-specific antigen failure and other-cause death using Weibull analysis.We included 612 patients who underwent laparoscopic radical prostatectomy for localized prostate cancer between June 2002 and December 2017. Risk classification was categorized by the D'Amico risk classification, and the patients were divided into three age groups:60, 60-69 and ≥70 years. The hazard rates at each point were derived using Weibull analysis. The optimal observation time after laparoscopic radical prostatectomy was determined as the intersection point at which the hazard rate of other-cause death overtakes the hazard rate of prostate-specific antigen failure.In all groups classified by age, the hazard rate of other-cause deaths increased over time. In contrast, the hazard rate of prostate-specific antigen failure decreased gradually. The ≥70 years age group showed the highest hazard rate. The hazard rate of prostate-specific antigen failure was highest in the high-risk group. The patients aged ≥70 and 60-69 years in the low-risk group were recommended 6 years 6 months and 14 years 8 months, respectively, for observation. The remaining patients were recommended25 years of postsurgical observation.The observation time after laparoscopic radical prostatectomy could be estimated by comparing the estimated hazard rates of prostate-specific antigen failure and other-cause death based on Weibull analysis. Urologists should pay attention to age and risk classifications for optimal postoperative observation.

Stereoselective construction of unprotected β -amino acids is a significant challenge owing to the lack of methods for the catalytic generation of highly enantioenriched carboxylic acid enolates. In this study, we developed a novel copper-catalyzed diastereo- and enantioselective reductive Mannich-type reaction of α,β -unsaturated carboxylic acids, which provides a direct and scalable synthetic method for enantioenriched β 2,3,3 -amino acids with vicinal stereogenic centers. Our protocol features in situ generation of transiently protected carboxylic acids by a hydrosilane and their diastereo- and enantioselective reductive coupling with ketimines. The synthetic utility of this process was demonstrated by a gram-scale reaction and the transformation of β -amino acids.

OBJECTIVE To evaluate functional outcomes over a year for benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate. METHODS In this study, we prospectively included 140 patients who were treated for benign prostatic hyperplasia from April 2017 to February 2019. A randomization list was used for non-blind assignment to treatment groups (thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate). The International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, uroflowmetry and International Index of Erectile Function-5 were used for the assessment of outcomes. Scores were taken before treatment, and at 1, 3, 6, 9 and 12 months after treatment. RESULTS Preoperatively, characteristics of patients in the thulium laser enucleation of the prostate group (n = 70) and the bipolar transurethral resection of the prostate group (n = 70) did not significantly differ. The thulium laser enucleation of the prostate group had a lower median decrease in hemoglobin (0.10 g/dL vs 0.69 g/dL, P

Using conditional survival (CS) analysis, we investigated whether the duration of survival without biochemical recurrence (BCR) of prostate cancer after laparoscopic radical prostatectomies (LRP) affected the BCR rate. We also investigated the impact of well-known risk factors for BCR.Between 2002 and 2014, 627 consecutive patients underwent LRPs at our institution. Prostate-specific antigen (PSA) concentrations above 0.2 ng/mL were defined as BCR. Conditional BCR-free survival rates were determined through Kaplan-Meier analysis. Assessment of potential BCR risk factors was performed using a Cox proportional hazard analysis.The 10-year BCR-free rates after LRP increased to 82.4%, 84.5%, 86.6%, 90.1%, and 94.7% in patients surviving 1, 2, 3, 5, and 7.5 years without BCR, respectively. Multivariate analyses of age, PSA concentrations, neoadjuvant therapy, and pathological findings were performed for all patients. In all patients, positive surgical margins (PSM) and Gleason Grade Groups (GG) ≥ 4 were independent risk factors for BCR (p 0.001, hazard ratio [HR] = 2.45; and p 0.001, HR = 2.83, respectively,). Similarly, PSM and GG ≥ 4 were significant risk factors in patients surviving 1-5 years without BCR. No clear risk factors were observed in patients surviving 5 years without BCR after LRPs.The BCR-free rate increased with time after LRP. It is recommended that patients with PSM, GG ≥ 4, or with both factors are strictly monitored for 5 years postoperatively. CS analysis is particularly useful for predicting the postoperative course of patients.

INTRODUCTION AND OBJECTIVE:There is currently insufficient evidence on the appropriate surveillance duration after low-dose-rate brachytherapy (LDR) with iodine-125 for localized prostate cancer (P...

Objective Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma. Methods The study included 65 patients with submandibular gland carcinoma who underwent initial surgical treatment at the Kyoto University and its affiliated hospitals. Results The 3-year overall survival (OS), disease specific survival, locoregional control (LRC), and no distant metastasis (NDM) rates were 74.2%, 74.2%, 90.0%, and 64.8%, respectively. In the current follow-up study, 16 patients died of the disease, 5 patients were alive with recurrence, 43 patients were alive without disease, and 1 patient died of unrelated disease without recurrence. All patients who died of the disease had developed distant metastasis. Based on univariate analysis, tumor grade (high grade) and lymph node metastases (≥N2) were significant prognostic factors for OS and LRC. It also revealed tumor grade (high grade), T classification (≥T3), and lymph node metastases (≥N2) were significant for distant metastasis. Multivariate analysis showed the following significant prognostic factors: lymph node metastases (≥N2) for OS, LRC, and NDM, and high tumor grade for NDM. Conclusion Our study suggested death of submandibular gland carcinoma occurred mainly due to distant metastasis. The significant predictors of distant metastasis were lymph node metastases (≥N2) and tumor grade (high grade).

A fall accident is an event that is associated with many disadvantages. In our hospital, 5,259 fall cases have been reported over the past 7 years according to our incident reports, and account for 16.5% of all incident reports. We conducted a detailed examination of 120 of these fall cases at the Department of Otolaryngology. Most of all, “before and after excretion” is a common fall-outbreak-motive reason for falls in all departments. In the field of otolaryngology, “use of drugs” and “walking disorder” are frequently encountered reasons for a fall. Calculation of age-specific fall rates revealed two peaks: around 0 years old and after 80 years old. It is suggested that a fall is associated with a reduced ability for maintaining the standing position. A correlation has been reported between the fall rate and the average length of hospitalization. Both the length of hospitalization of 12.3 days and fall rate of 1.97 among the cases seen at the Department of Otolaryngology are lower than all courses that are in other fields, on average. In the patients seen at the Department of Otolaryngology, the fall rate rises significantly as the length of hospitalization increases. In the Department of Otolaryngology, the fall rate of the malignancy group is high (2.91), irrespective of the treatment regimens. Each of the three items—“14 hospitalization days or more,” “65 years old or older,” and “malignancy”—contributes to falls in patients seen at the Department of Otolaryngology, and multivariate analysis revealed a particularly strong contribution of the previous two items. In elderly patients with expected long-term hospitalization, it is necessary to proactively attempt risk reduction; we first make all patients aware of the risk of long-term hospitalization at the first examination, and divide length of stay into multiple times. We review the assessment score after reexamining the “disease severity” and “performance status” as risk factors for falls, and want to realize more efficient measures for preventing falls in the future.

The management of patients with cervical metastasis in head and neck cancer of unknown primary (HNCUP) remains controversial. This current multicenter retrospective study investigated the treatment outcomes of patients with HNCUP.The study included patients who were treated curatively at 12 institutions in Japan from January 2006 to December 2015.Eighty patients with HNCUP were included. The median follow-up period was 34 months. The three-year overall survival (OS), disease-specific survival (DSS), regional relapse-free survival (RRFS), local progression-free survival (LPFS), and distant metastasis-free survival (DMFS) rates were 72.5%, 80.3%, 74.0%, 89.7%, and 86.9%, respectively. Nodal status was a significant factor for OS, DSS, RRFS, and DMFS; and extracapsular extension (ECE) was significant for OS and DSS. There was a distinct difference between the survival rates of patients with N1-2a and N2b-3 disease. RT was a significant positive factor for LPFS (3-year LPFS, RT 93.0% vs. no RT 83.0%, p = .043).For N2a as well as N1 disease without ECE, a single treatment modality, including ND or RT alone is acceptable. When ND alone is performed, thorough monitoring should be continued during follow-up to identify the emergence of the primary lesion.

Tokyo Gas has developed a residential fuel cell CHP system named “ENE-FARM” jointly with Panasonic, and began to sell ENE-FARM as the world’s first commercial fuel cell cogeneration system in May 2009. Following the first-generation model of ENE-FARM, the second-generation was released in 2011, and the third-generation in 2013. The cumulative sales of ENE-FARM have reached 40,000 units as of January 2015. After the third-generation, the new fourth-generation model of ENE-FARM has been launched since April 2015. This new model was developed in order to meet customer expectations such as reduced cost, integration of optional units for a power outage and greater flexibility of installation. These improvements can contribute to the customer satisfactions and the expansion of ENE-FARM spread. In this paper, specifications and main features of the new model ENE-FARM are described

Objective Salivary gland carcinoma is rare among head and neck cancers. Sublingual gland carcinoma, a type of salivary gland carcinoma, is even rarer; therefore, the number of cases at a single institute is too small for sufficient evaluation of tumor characteristics. We conducted a multicenter, retrospective analysis of sublingual gland carcinomas in patients who visited 12 institutions associated with the Kyoto Hospital and Affiliated Facilities Head and Neck Clinical Oncology Group. Methods Thirteen previously untreated patients who visited the institutions between 2006 and 2015 were enrolled. The overall survival (OS) and disease-free survival (DFS) rates for all patients and by disease stage were analyzed. Statistical analyses were performed for all patients with respect to disease stage. Results Eight of thirteen patients were diagnosed with adenoid cystic carcinoma on pathological study. A significant difference in OS rate was observed between patients with Stage I–III and Stage IV disease; however, the difference in DFS rate by disease stage was not significant. Conclusion Stage IV disease was identified as a poor prognostic factor in patients with sublingual gland carcinoma. However, even patients with Stage I–III disease experienced relatively short DFS. Distant metastasis is a serious problem among patients with sublingual gland carcinoma.

Adenoid cystic carcinoma of the head and neck (ACCHN) is rare and difficult to study effective treatment at one institute. Our aim is to identify prognostic factors for this disease by conducting a multicenter study at 11 institutions in Japan.A retrospective multicenter study of ACCHN was performed. One hundred and three patients were identified between 2006 and 2015. The overall survival (OS) rate for all patients was calculated, and OS, locoregional control (LRC) rate, or no distant metastasis (NDM) rate was calculated for patients in that the surgery was performed without distant metastasis (DM). Statistical analyses were performed.A significant difference with multivariate analysis was observed in patients in sublingual glands, stage IV and the use of radiation therapy ≥60Gy (sufficient RT) in OS for all patients. A significant difference was observed in the use of sufficient postoperative RT in the OS and the LRC rate, and in pathological surgical margins in the NDM rate.Sublingual glands or stage IV was a poorer, and sufficient RT was a better prognostic factor for ACCHN. Sufficient RT was effective to prevent local recurrence after surgical resection. Positive surgical margins caused an increase in DM.

5-(3,4,5-Trimethoxybenzoyl)-4-amimopyrimidine derivatives were found as a novel chemical class of potent and highly selective phosphodiesterase 5 inhibitors. A pseudo-ring formed by an intramolecular hydrogen bond constrained the conformation of 3-chloro-4-methoxybenzylamino and 3,4,5-trimethoxybenzoyl substituents and led to the discovery of T-6932 (19a) with a potent PDE5 inhibitory activity (IC50 = 0.13 nM) and a high selectivity over PDE6 (IC50 ratio: PDE6/PDE5 = 2400). Further modification at the 2-position of T-6932 resulted in the finding of 26, which exhibited potent relaxant effects on isolated rabbit corpus cavernosum (EC30 = 11 nM) with a high PDE5 selectivity over PDE6 (IC50 ratio: PDE6/PDE5 = 2800).

Mitofish is a database of fish mitochondrial genomes (mitogenomes) that includes powerful and precise de novo annotations for mitogenome sequences. Fish occupy an important position in the evolution of vertebrates and the ecology of the hydrosphere, and mitogenomic sequence data have served as a rich source of information for resolving fish phylogenies and identifying new fish species. The importance of a mitogenomic database continues to grow at a rapid pace as massive amounts of mitogenomic data are generated with the advent of new sequencing technologies. A severe bottleneck seems likely to occur with regard to mitogenome annotation because of the overwhelming pace of data accumulation and the intrinsic difficulties in annotating sequences with degenerating transfer RNA structures, divergent start/stop codons of the coding elements, and the overlapping of adjacent elements. To ease this data backlog, we developed an annotation pipeline named MitoAnnotator. MitoAnnotator automatically annotates a fish mitogenome with a high degree of accuracy in approximately 5 min; thus, it is readily applicable to data sets of dozens of sequences. MitoFish also contains re-annotations of previously sequenced fish mitogenomes, enabling researchers to refer to them when they find annotations that are likely to be erroneous or while conducting comparative mitogenomic analyses. For users who need more information on the taxonomy, habitats, phenotypes, or life cycles of fish, MitoFish provides links to related databases. MitoFish and MitoAnnotator are freely available at http://mitofish.aori.u-tokyo.ac.jp/ (last accessed August 28, 2013); all of the data can be batch downloaded, and the annotation pipeline can be used via a web interface.

Intramusucular hemangioma is a benign neoplasm frequently arising from the skeletal muscles of the trunk and extremities. Involvement of the head and neck by this tumor is rare, even though the majority of such tumors originate from the masseter and the trapezius. Preoperative diagnosis is very difficult because of the rarity and the distribution of these tumors in the deep space. We report on a rare case of intramuscular hemangioma, involving the posterior cricoarytenoid muscle. A 82-year-old female patient with an abnormal sensation in her throat, was found to have a tumor in the left piriform sinus. Thus we performed biopsies twice, but the pathology was not confirmed, with a report of just normal mucosa. However we speculated that the tumor was benign and so performed a lateral neck exploration. The tumor was completely removed. Histological examination revealed it to be an intramuscular hemangioma of the skeletal muscle. Based on the intraoperative findings of the tumor, we diagnosed it as an intramuscular hemanginoma originating from the posterior cricoarytenoid muscle. As the posterior cricoarytenoid muscle opens the glottal space, the left vocal cord was fixed medially after the surgery. Nevertheless its tonus appeared fine and phonetic function remained normal.

Primary tracheal cancer is very rare and a tumor obstructing the airway is an emergency difficult to manage. We report a case of primary tracheal cancer requiring surgery using percutaneous cardiopulmonary support (PCPS). A 68-year-old man was referred of severe dyspnea and squamous cell carcinoma obstructing the subglottic laryx found in bronchoscopy. Computed tomography (CT) showed a tumor extending from the cricoid cartilage to the third tracheal ring. We diagnosed tracheal cancer because most of the lesion was in the tracheal wall. Because dyspnea was getting worse, we performed emergency surgery. PCPS was established before tracheostomy for airway management. We performed total wide-field laryngectomy with the inferior margin located at the seventh tracheal ring. Using PCPS helps keep the operation uneventful and successful. Despite postoperative chemoradiotherapy, mediastinal lymph node and lung metastases 8 months post-operatively led to the man's death 15 months later. PCPS is very simple and easy to control, and has proven very effective in cases of severe airway stenosis.

近年，PET/CTが頭頸部扁平上皮癌の頸部リンパ節転移診断に有用との報告が散見され，当科でも治療前のN分類の決定にPET/CTを用いている。今回，当科で頸部郭清術を行った症例の術前PET/CTと術後病理診断を比較し，頸部リンパ節転移診断におけるPET/CTの有用性を検討した。対象は，PET/CT施行後1ヶ月以内に頸部郭清術を行い，なおかつ導入化学療法などの術前治療を行わなかった42例59側で，術前PET/CTで転移陽性と診断した23側のうち術後病理で転移リンパ節を認めたのは19側，PET/CTで転移陰性と診断した36側のうち術後病理で転移リンパ節を認めなかったのは33側であった。感度は86%，特異度は89%であり，頸部リンパ節転移診断においてPET/CTは有用であると考えられたが，偽陽性や偽陰性例の存在に留意する必要がある。

Although secondary structure predictions of an individual RNA sequence have been widely used in a number of sequence analyses of RNAs, accuracy is still limited. Recently, we proposed a method (called 'CentroidHomfold'), which includes information about homologous sequences into the prediction of the secondary structure of the target sequence, and showed that it substantially improved the performance of secondary structure predictions. CentroidHomfold, however, forces users to prepare homologous sequences of the target sequence. We have developed a Web application (CentroidHomfold-LAST) that predicts the secondary structure of the target sequence using automatically collected homologous sequences. LAST, which is a fast and sensitive local aligner, and CentroidHomfold are employed in the Web application. Computational experiments with a commonly-used data set indicated that CentroidHomfold-LAST substantially outperformed conventional secondary structure predictions including CentroidFold and RNAfold.

阪神高速道路8号京都線稲荷山トンネル山科坑口部は坑口を出てから交差点までの距離が約140mと短く，トンネル内を走行した車両が十分に減速できない可能性があることが危惧されていた．その解決策として，従来は建築等の分野で緊張感緩和等のために採用されているシークエンスデザインを，交通安全対策の手法として利用することを発案し，シークエンスデザインが運転者に与える影響についてアンケート等を通じて検討を行い，トンネルへの応用方法について検討した．そしてCG動画を用いた室内実験や完成後の実車実験により，検討したシークエンスデザインによる速度抑制効果を定量的に検証した．

We report a very rare case of an esophageal diverticulum following anterior cervical fusion. A 58-year-old woman underwent 2-level anterior cervical fusion with allograft and anterior plating. Postoperatively, she complained of dysphagia such as discomfort during swallowing and was diagnosed with an esophageal diverticulum based on barium swallow study. It was decided to excise the diverticulum via an external approach. In a discussion with the patient, the plate was also removed by orthopedists. The patient made a good recovery and she has remained symptom-free to date. An esophageal diverticulum following anterior cervical fusion is a very rare complication. We found only 7 cases of esophageal diverticulum following anterior cervical fusion in the English literature.

Several lines of evidence have revealed that ubiquitylation of membrane proteins serves as a signal for endosomal sorting into lysosomes or lytic vacuoles. The hepatocyte growth factor-regulated tyrosine kinase substrate (Hrs) interacts with ubiquitylated cargoes through its ubiquitin-interacting-motif domain (UIM domain), and plays an essential early role in endosomal sorting. Here, we show that the C-terminal region of Hrs, which does not contain the UIM domain, can bind to interleukin-2 receptor beta (IL-2Rbeta). We found a direct interaction between bacterially expressed IL-2Rbeta and Hrs in GST pull-down assays, indicating that their binding is independent of ubiquitin. Trafficking and degradation assays revealed that, similarly to wild-type IL-2Rbeta, an IL-2Rbeta mutant lacking all the cytoplasmic lysine residues is sorted from Hrs-positive early endosomes to LAMP1-positive late endosomes, resulting in degradation of the receptor. By contrast, an IL-2Rbeta mutant lacking the Hrs-binding region passes through early endosomes and is mis-sorted to compartments positive for the transferrin receptor. The latter mutant exhibits attenuated degradation. Taken together, these results indicate that precise sorting of IL-2Rbeta from early to late endosomes is mediated by Hrs, a known sorting component of the ubiquitin-dependent machinery, in a manner that is independent of UIM-ubiquitin binding.

Reinke's edema is a condition characterized by diffuse polypoid changes in the subepithelial superficial lamina propria of the vocal cords, which is usually treated using the minimally invasive microflap technique. However, in patients with dyspnea, the epithelium has often undergone pathological changes due to repeat infection and hemorrhage. During the resection of such bulky, inflamed lesions, the operative field is compromised by bleeding, which can result in complications. We report two patients with severe Reinke's edema who presented with a chief complaint of dyspnea. In both patients, emergency tracheostomy was performed immediately before the curative resection of the lesion with the laryngeal microdebrider. The procedures were promptly completed with good visualization. No complication occurred and the patients were satisfied with the vocal outcome one month after the treatment. Although few reports are available on the use of the microdebrider in inflammatory lesions of the vocal cords, our experience showed its usefulness in selected cases of Reinke's edema.

OBJECTIVE The aim of this study was to detect prognostic factors in patients with locally advanced papillary thyroid carcinoma. PATIENTS The study included 72 patients (T4a/T4b 72/0, N0/N1a/N1b 25/15/32, M0/M1 68/4, mean follow-up 8.1 4.4 years) who underwent initial surgical treatment at Osaka Red Cross Hospital between April 1993 and April 2011. RESULTS Eleven patients died of PTC, 3 patients with recurrence died of unrelated disease and 10 patients are alive with recurrence. The overall 5-year survival rate was 88.3%, and the 10-year survival rate was 73.4%. The disease-specific 5-year survival rate was 91.4%, and the 10-year survival rate was 88.6%. The 5-year local control rate was 94.1%, and the 10-year local control rate was 85.4%. Patients with distant metastasis (M1), tracheal invasion and/or multiple organs invasion showed a significantly worse disease-specific survival rate based on a univariate analysis, which also revealed that tracheal invasion, laryngeal invasion, esophageal invasion and multiple organs invasion were risk factors linked to the development of distant metastasis during follow-up (recurrence as distant metastasis). The following were found to be clinically significant risk factors, based on the multivariate analysis among tracheal invasion, laryngeal invasion, esophageal invasion and recurrent laryngeal nerve invasion : Tracheal invasion was a risk factor for disease-specific survival, and tracheal invasion and laryngeal invasion were risk factors for recurrence as distant metastasis. CONCLUSIONS In this study, distant metastasis, multiple organs invasion, tracheal invasion and/or laryngeal invasion were shown to be higher risk factors.

A novel series of highly selective phosphodiesterase 5 (PDE5) inhibitors was found. 8H-Pyrido[2,3-d]pyrimidin-7-one derivatives bearing an (S)-2-(hydroxymethyl)pyrrolidin-1-yl group at the 2-position and a 3-chloro-4-methoxybenzyl group at the 8-position exhibited potent PDE5 inhibitory activities and high PDE5 selectivity over PDE6. Among the synthesized compounds, the 5-methyl analogue (5b) showed the most potent relaxant effect on isolated rabbit corpus cavernosum with an EC30 value of 0.85 nM.

Genomic analysis of integration will be important in evaluating the safety of human gene therapy with retroviral vectors. Here, we investigated MLV vector integration sites in human T-cells, since they are amenable to gene transfer studies, and have been used therapeutically in clinical trials. We mapped 340 MLV vector integration sites in the infected human T-cell clones we established. The data showed that MLV preferred integration near the transcription start sites (+/-5kb), near CpG islands (+/-1kb), and within the first intron of RefSeq genes. We also identified MLV integration hot spots that contained three or more integrations within a 100kb region. RT-PCR revealed that mRNA-levels of T-cell clones that contained MLV integrations near transcription start sites or introns were dysregulated compared to the uninfected cells. These studies help define the profile of MLV integration in T-cells and the risks associated with MLV-based gene therapy.

In Renormalization Group MD (RGMD) performed using atomic-cluster-based particles, Inverse Renormalized MD (IRMD) is carried out on specified occasions to observe atomic motion in clusters. Then, on the begining of the IRMD, it is necessary to determine initial positions and velocities of atoms in clusters such that physical and/or mechanical coditions of clusters are consistent with those of member atoms. This paper proposes a new method, in which the intial model of the IRMD is generated taking into account the equilibrium of forces in and between clusters, incremental strain state and temperature in clusters. Initial model generation based on the new method has been carried out, for a case of Mode I crack propagation, using an RMD model extracted from MD simulation. It is shown that an initial model containing amorphous state around a crack tip can be generated using the proposed method.

Objective: Attenuation artifacts adversely affect the diagnostic accuracy of myocardial perfusion imaging. We assessed the clinical usefulness of X-ray CT based attenuation correction (AC) in patients undergoing myocardial perfusion imaging by comparing their myocardial AC- and non-corrected (NC) SPECT images with the coronary angiography (CAG).Methods: We retrospectively reviewed the myocardial SPECT images of 30 patients (18 men, 12 women; mean age 68 years). Thirteen of 30 patients with coronary artery disease (CAD) and 17 without CAD were confirmed by CAG. They underwent sequential CT and myocardial SPECT imaging with thallium-201 (111 MBq) under an exercise or pharmacological stress protocol using our combined SPECT/ CT system. Two readers reviewed the myocardial SPECT images for the presence of CAD on a 4-point scale where 1 = normal, 2 = probably normal, 3 = probably abnormal, and 4 = abnormal. Two reading sessions were held. First, non-corrected (NC)-SPECT and second, AC-SPECT images using X-ray CT images were interpreted. Interobserver variability was assessed with kappa statistics. Diagnostic performance (accuracy) of coronary arterial stenosis was compared between AC- and NC-images.Results: Interobserver agreement for visual assessment was substantial or almost perfect. For AC-images, the observer consensus for analysis was 0.84 for the LAD-, 0.87 for the LCX-, and 0.71 for the RCA-territory. For NC-images, it was 0.91, 0.71, and 0.78. AC resulted in statistically significant improvements in overall diagnostic accuracy (sensitivity/ specificity/accuracy = 76%/93%/89%, 67%/86%/81%, respectively, for AC- and NC-images).Conclusions: Because of an increase in the specificity, diagnostic accuracy was significantly increased on AC-images. These preliminary data suggest that X-ray CT based AC in myocardial SPECT imaging has the potential to develop into a reliable clinical technique.