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Background: Fecal immunochemical tests are commonly performed for colorectal cancer screening. Instant fecal occult blood measurement in toilet bowel movements would improve convenience. Hyperspectral imaging (HSI) enables the nondestructive evaluation of materials that are difficult to assess visually. This study aimed to determine whether HSI could be used to identify fecal occult blood on stool surfaces., Methods: The study included 100 patients who underwent colonoscopy, divided into groups A and B (50 patients, each) for creating a discriminant algorithm and validating the accuracy of the algorithm, respectively. In group A, 100 areas were randomly selected from the stool surface, and the fecal occult blood quantitative values were measured and photographed using a hyperspectral camera (cutoff: > 400 ng/mL). A discriminant algorithm image was created to extract spectral feature differences obtained from HSI via machine learning. In group B, 250 random areas were evaluated and compared to fecal occult blood quantitative values, measuring sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV)., Results: Groups A and B comprised 28 and 26 patients with cancer, respectively. Cancer detection sensitivity at the 400 ng/mL cutoff was 67.9% and 42.3% in groups A and B, respectively. The discriminant algorithm image exhibited high accuracy in group A (sensitivity; 77.1%, specificity; 96.9%, accuracy; 90.0%, PPV; 93.1%, NPV; 88.7%). In group B, the sensitivity, specificity, accuracy, PPV, and NPV were 83.3, 92.9, 90.8, 76.3, and 95.3%, respectively., Conclusion: HSI can effectively discriminate high quantitative fecal occult blood, highlighting its potential for improved colorectal cancer screening., (© 2024. The Author(s).)

Background: The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in clinical settings to assess the severity of alcohol-related problems, with the effectiveness of alcohol reduction interventions varying across this spectrum. In a recent study, we demonstrated that a 12-week intervention involving the provision of free non-alcoholic beverages reduced alcohol consumption among heavy drinkers for up to 8 weeks post-intervention. However, it remains unclear whether this effect was consistent across different AUDIT score ranges. Therefore, this secondary analysis aimed to examine whether the severity of alcohol-related problems, as indicated by AUDIT scores, influences the effectiveness of non-alcoholic beverage provision in reducing alcohol consumption., Methods: This was a single-center, open-label, randomized, parallel-group study. Participants were Japanese individuals who frequently consumed large quantities of alcohol (at least 40 g/day for men and 20 g/day for women) but were not diagnosed with alcohol dependence. Participants were randomly assigned to either an intervention or control group. The intervention group received free non-alcoholic beverages once every 4 weeks over a 12-week period (24 bottles of 350 mL per case, up to three cases per session, for a total of three sessions). Alcohol and non-alcoholic beverage consumption over the previous 4 weeks was tracked using a drinking diary. For this secondary analysis, participants were categorized into four groups based on their AUDIT scores (group 1: ≤ 7 points, group 2: 8-11 points, group 3: 12-14 points, and group 4: ≥ 15 points), and changes in alcohol consumption were compared across these groups in both the intervention and control participants., Results: The provision of non-alcoholic beverages significantly increased non-alcoholic beverage consumption in all groups. However, alcohol consumption was significantly reduced in the intervention groups compared to controls only in groups 1-3. The reduction in alcohol consumption was less pronounced in groups 3 and 4 compared to group 1 (both, p < 0.05). Importantly, the provision of non-alcoholic beverages did not lead to an increase in alcohol consumption, even among individuals with higher AUDIT scores., Conclusions: These findings suggest that individuals with higher AUDIT scores may experience a reduced benefit from a 12-week non-alcoholic beverage intervention in terms of alcohol consumption reduction. Nevertheless, this intervention appears to be a safe and effective strategy for reducing alcohol consumption in heavy drinkers who do not have alcohol dependence., Trial Registration: UMIN UMIN000047949. Registered 4 June 2022., (© 2024. The Author(s).)

Background: It is unclear whether brief interventions using the combined classification of alcohol-metabolizing enzymes aldehyde dehydrogenase 2 (ALDH2) and alcohol dehydrogenase 1B (ADH1B) together with behavioral changes in alcohol use can reduce excessive alcohol consumption. This study aimed to examine the effects of a brief intervention based on the screening of ALDH2 and ADH1B gene polymorphisms on alcohol consumption in Japanese young adults., Methods: In this open-label randomized controlled trial, we enrolled adults aged 20-30 years who had excessive drinking behavior (average amount of alcohol consumed: men, ≥  4 drinks/per day and women, ≥  2 drinks/per day; 1 drink = 10 g of pure alcohol equivalent). Participants were randomized into intervention or control group using a simple random number table. The intervention group underwent saliva-based genotyping of alcohol-metabolizing enzymes (ALDH2 and ADH1B), which were classified into five types. A 30-min in-person or online educational counseling was conducted approximately 1 month later based on genotyping test results and their own drinking records. The control group received traditional alcohol education. Average daily alcohol consumption was calculated based on the drinking diary, which was recorded at baseline and at 3 and 6 months of follow-up. The primary endpoint was average daily alcohol consumption, and the secondary endpoints were the alcohol-use disorder identification test for consumption (AUDIT-C) score and behavioral modification stages assessed using a transtheoretical model., Results: Participants were allocated to the intervention (n = 100) and control (n = 96) groups using simple randomization. Overall, 28 (29.2%) participants in the control group and 21 (21.0%) in the intervention group did not complete the follow-up. Average alcohol consumption decreased significantly from baseline to 3 and 6 months in the intervention group but not in the control group. The reduction from baseline alcohol consumption values and AUDIT-C score at 3 months were greater in the intervention group than in the control group (p < 0.001). In addition, the behavioral modification stages were significantly changed by the intervention (p < 0.001)., Conclusions: Genetic testing for alcohol-metabolizing enzymes and health guidance on type-specific excessive drinking may be useful for reducing sustained average alcohol consumption associated with behavioral modification., Trial Registration: R000050379, UMIN000044148, Registered on June 1, 2021., (© 2024. The Author(s).)

Background: We recently demonstrated that a 12-week intervention consisting of the provision of free non-alcoholic beverages reduced alcohol consumption in excessive drinkers for 8 weeks after the intervention. However, gender differences in this effect were not explored. Thus, this secondary analysis investigated gender differences in the influence of non-alcoholic beverage provision on alcohol consumption., Methods: Individuals who frequently drank excessively (at least 40 g/day in men and 20 g/day in women) and who were not diagnosed with alcoholism were recruited. Participants were randomized into the intervention or control group by simple randomization using a random number table. In the intervention group, free non-alcoholic beverages were provided once every 4 weeks for 12 weeks (three times in total). The consumption of alcoholic and non-alcoholic beverages was calculated based on a drinking diary submitted with the previous 4 weeks' of data. In this study, we compared the longitudinal changes in alcohol consumption between genders in both groups., Results: The provision of non-alcoholic beverages significantly reduced alcohol consumption in both genders; however, significant differences in alcohol consumption between the control and intervention groups were observed only in men. The average alcohol consumption during the intervention fell below the level associated with a high risk of non-communicable diseases in men (32.7 g/day), but not in women (24.8 g/day). Correlation coefficient analysis showed that replacing alcoholic beverages with the provided non-alcoholic beverages resulted in different drinking patterns according to gender. The percent changes in the consumption of alcoholic and non-alcoholic beverages relative to baseline levels did not differ between genders., Conclusions: Our results suggest that the provision of non-alcoholic beverages reduced alcohol consumption irrespective of gender. Of note, providing non-alcoholic beverages might be particularly useful for reducing high-risk alcohol consumption in male excessive drinkers., Trial Registration: UMIN UMIN000047949. Registered 4 June 2022., (© 2024. The Author(s).)

Aims: To assess the impact of various patient characteristics on the dynamics of liver glucose metabolism using automated multiparametric imaging with whole-body dynamic 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)., Materials and Methods: We retrospectively enrolled 540 patients who underwent whole-body dynamic FDG-PET. Three quantitative indices representing hepatic glucose metabolism [mean standardized uptake value normalized by lean body mass (SULmean), metabolic glucose rate (kinetic index) and distribution volume (DV)] were measured from multiparametric PET images produced automatically based on the Patlak plot model. Patient characteristics including age, sex, body mass index, fasting time, blood glucose level, and the presence of diabetes mellitus (DM) or hepatic steatosis (HS) were collected. We examined the correlations between the characteristic factors and three quantitative indices using multiple regression analysis., Results: The success rate of kinetic analysis using multiparametric PET imaging was 93.3% (504/540). Hepatic SULmean was significantly correlated with age (p < .001), sex (p < .001) and blood glucose level (p = .002). DV was significantly correlated with age (p = .033), sex (p < .001), body mass index (p = .002), fasting time (p = .043) and the presence of HS (p = .002). The kinetic index was significantly correlated with age (p < .001) and sex (p = .004). In the comparison of the healthy, DM and HS groups, patients with DM had a significantly increased SULmean, whereas patients with HS had a significantly decreased DV., Conclusions: Our results showed that liver glucose metabolism was influenced by various patient characteristic factors. Multiparametric FDG-PET imaging can be used to analyse the kinetics of liver glucose metabolism in routine clinical practice., (© 2023 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

Background: The use of alcohol-flavored beverages not containing alcohol (hereinafter referred to as non-alcoholic beverages) is recommended to reduce alcohol consumption. However, it is unclear if this reduces excessive drinking., Objective: To verify whether non-alcoholic beverages impact the alcohol consumption of excessive drinkers., Study Design: Single-center, open-label, randomized, parallel-group study., Methods: Participants aged 20 years or older who were not diagnosed with alcoholism, who drank at least four times a week, and whose alcohol consumption on those days was at least 40 g in males and 20 g in females, were recruited. Participants were randomized into the intervention or control group by simple randomization using a random number table. In the intervention group, free non-alcoholic beverages were provided once every 4 weeks for 12 weeks (three times in total), and thereafter, the number of alcoholic and non-alcoholic beverages consumed were recorded for up to 20 weeks. The consumption of alcoholic and non-alcoholic beverages was calculated based on a drinking diary submitted with the previous 4 weeks of data. The primary endpoint was the change from baseline in total alcohol consumption during past 4 weeks at week 12. The participants were not blinded to group allocations., Results: Fifty-four participants (43.9%) were allocated to the intervention group and 69 (56.1%) to the control group. None of the participants in the intervention group dropped out, compared to two (1.6%) in the control group. The change in alcohol consumption was - 320.8 g (standard deviation [SD], 283.6) in the intervention group and - 76.9 g (SD, 272.6) in the control group at Week 12, indicating a significant difference (p < 0.001). Even at Week 20 (8 weeks after the completion of the intervention), the change was - 276.9 g (SD, 39.1) in the intervention group, which was significantly greater than - 126.1 g (SD, 41.3) in the control group (p < 0.001). The Spearman rank correlation coefficient between the change in non-alcoholic beverage consumption and alcohol consumption at Week 12 was significantly negative only in the intervention group (ρ =  - 0.500, p < 0.001). There were no reports of adverse events during the study., Conclusions: Providing non-alcoholic beverages significantly reduced alcohol consumption, an effect that persisted for 8 weeks after the intervention., Trial Registration: UMIN UMIN000047949. Registered 4 June 2022., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Obesity and diabetes are serious, chronic medical conditions associated with a wide range of life-threatening conditions. The aim of this study was to investigate the effects of the edible red seaweed Gloiopeltis furcata (Postels et Ruprecht) J. Agardh ( G. furcata ) on the development of obesity, diabetes and related metabolic diseases in mice. Male C57BL/6J mice were fed a high-fat (HF) diet (60% energy as fat), or an HF diet containing 2% (w/w) or 6% powdered G. furcata for 13 weeks. Polysaccharides of G. furcata were isolated and their anti-inflammatory effects were evaluated in lipopolysaccharide-stimulated RAW264.7 cells. The HF diet group showed greater weight gain, lipid accumulation in the body and liver, and increased serum levels of glucose and cholesterol in comparison to the normal group fed a normal diet (10% energy as fat). The treatment of HF diet mice with G. furcata reduced these changes and stimulated the fecal excretion of fat. In addition, G. furcata suppressed the HF diet-induced elevation of inflammation and oxidative stress markers in the serum and liver. The isolated sulfated polysaccharide from G. furcata inhibited pancreatic lipase activity and decreased the production of nitric oxide and TNF-α in the murine macrophage cell line RAW264.7. These results show that G. furcata treatment can attenuate obesity, diabetes, hepatic steatosis, and dyslipidemia in mice fed an HF diet, which is associated with inhibited intestinal fat absorption and reduced inflammation and oxidative stress by a sulfated polysaccharide., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: The alcohol-metabolizing enzyme aldehyde dehydrogenase 2 (ALDH2) is a carcinogenic acetaldehyde-degrading enzyme, and its low activity is a genetic constitution peculiar to East Asians. People with low alcohol dehydrogenase 1B activity (ADH1B*1/*1 genotype) have a high risk of developing head and neck cancer and alcoholism. The study aims to evaluate the effectiveness of brief interventions for excessive drinking among college students and adults in their 20s, including information on five constitutions that combine the ALDH2 and ADH1B genotypes., Methods: Participants comprised university students and staff aged 20-30 years who had consumed ≥40 g (males) or ≥20 g (females) of pure alcohol; they were classified into intervention and control groups using a simple randomization method. Participants anonymously filled out questionnaires linked to identification numbers and recorded the drinking days and amounts on the drinking calendar. The intervention group will then be tested for genotype testing using saliva (5 types of combinations of ALDH2 and ADH1B enzyme activities); the result report will arrive approximately 1 month later. We will conduct a 30-min face-to-face or online intervention. The control group will be merely given the conventional materials, and genetic testing will be performed voluntarily after 6 months (end of study). The intervention group will undergo questionnaire surveys 1 month after the intervention and 3 and 6 months after baseline. Questionnaire surveys will be conducted 1, 3, and 6 months after baseline for the control group. The average amount of drinking before and after the intervention, attribute/baseline data between the two groups, and time-series data were compared using various analysis tools. For interventions, we engaged in dialog based on intervention materials that added genotyping content to the existing materials, result reports, baseline data, and drinking calendar records. Participants' ingenuity is respected to support their drinking behavior and goal setting., Discussion: Individual information on the genetic makeup of alcohol-metabolizing enzymes provided during the intervention is more personal and objective than general health information, especially in Japan, where the ALDH2 low activity rate is high. This information may be useful for health care and precautionary measures., Trial Registration: R000050379, UMIN000044148, Registered on June 1, 2021. Scientific Title: Examination of simple intervention using genetic polymorphism information for excessive drinking., (© 2022. The Author(s).)

The human gut is a complex microbial ecosystem comprising approximately 100 trillion microbes collectively known as the "gut microbiota". At a rough estimate, the human gut microbiome contains almost 3.3 million genes, which are about 150 times more than the total human genes present in the human genome. The vast amount of genetic information produces various enzymes and physiologically active substances. Thus, the gut microbiota contributes to the maintenance of host health; however, when healthy microbial composition is perturbed, a condition termed "dysbiosis", the altered gut microbiota can trigger the development of various gastrointestinal diseases. The gut microbiota has consequently become an extremely important research area in gastroenterology. It is also expected that the results of research into the gut microbiota will be applied to the prevention and treatment of human gastrointestinal diseases. A randomized controlled trial conducted by a Dutch research group in 2013 showed the positive effect of fecal microbiota transplantation (FMT) on recurrent Clostridioides difficile infection (CDI). These findings have led to the development of treatments targeting the gut microbiota, such as probiotics and FMT for inflammatory bowel diseases (IBD) and other diseases. This review focuses on the association of the gut microbiota with human gastrointestinal diseases, including CDI, IBD, and irritable bowel syndrome. We also summarize the therapeutic options for targeting the altered gut microbiota, such as probiotics and FMT., Competing Interests: Conflict-of-interest statement: No conflict of interest., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Acute esophageal necrosis (AEN), commonly referred to as Gurvits syndrome or "black esophagus", is a rare clinical disease. We present a case of AEN associated with diabetic ketoacidosis (DKA)., Case Presentation: A 66-year-old male came to our hospital with coffee-ground emesis, dyspnea, and general malaise. He was treated for type 2 diabetes mellitus using insulin and had not been taking his medication, including insulin, for several days. Laboratory analysis revealed severe hyperglycemia (730 mg/dL), normocytic anemia (hemoglobin level, 7.7 g/dL; mean corpuscular volume, 100.4 fL), high serum potassium (7.6 mEq/L), and a high level of blood urea (98.7 mg/dL). Ketones and glucose were detected in the urine, and serum β-hydroxybutyrate was elevated (2132 µmol/L). Arterial blood gas analysis confirmed metabolic acidosis (pH, 7.29; HCO 3 , 10.5 mmol/L). Collectively, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient's condition improved with intravenous fluids, and he received intravenous insulin to treat DKA. According to these findings, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient underwent esophagogastroduodenoscopy (EGD) which revealed a circumferential necrosis of the middle and distal esophagus, immediately proximal to the gastroesophageal junction. The patient was then treated with an intravenous proton pump inhibitor. The patient continued to improve with conservative treatment and was subsequently discharged in a stable condition. An EGD repeated 14 days after discharge showed complete healing of the necrotic-like mucosal change without stricture formation of the esophagus., Conclusions: AEN is rare but potentially life-threatening case of upper gastrointestinal bleeding. Therefore, a clinician should be aware of AEN as a potential cause of upper gastrointestinal bleeding in elderly patients with poorly controlled diabetes and significant comorbidities., (© 2022. The Author(s).)

Objective: This study aimed to investigate the appropriate Silicon photomultiplier -PET/CT acquisition and image reconstruction conditions for each age group., Methods: The original phantom was developed to reflect the thickness and width of the torso in each age group (neonates, 1-year-olds, 5-year-olds, 10-year-olds, 15-year-olds, and adults). The ratio of hot spheres to background radioactivity was 4:1, and the radioactivity concentration was adjusted according to the Japanese consensus guidelines for appropriate implementation of pediatric nuclear medicine examinations. We evaluated the root mean square error (RMSE) as an assessment/function of the standardized uptake value of each hot sphere, the background variability (N10 mm), the % contrast of the hot sphere (QH, 10 mm/N10 mm), and the noise equivalent counts to determine the optimal reconstruction parameters and the appropriate acquisition time., Results: The minimum RMSE was obtained by setting the half-width of the Gaussian filter to 0-2 mm for iteration 1 or 2 and to 2-4 mm for iteration 3 or more. The acquisition times that satisfied the image quality equivalent to 120 s acquisitions in the adult phantoms were 30 s in the neonatal and 1-year-old phantoms, 60 s in the 5- and 10-year-old phantoms, and 75 s in the 15-year-old phantoms., Conclusion: This study demonstrated that good PET images could be obtained with short acquisition times when the examination is performed under appropriate reconstruction conditions., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To assess the effects of deep learning image reconstruction (DLIR) and hybrid iterative reconstruction (HIR) on the image quality of virtual monochromatic spectral (VMS) images and to investigate the dose reduction potential of the VMS and conventional 120 kVp images., Methods: A cylindrical phantom simulating an adult abdomen was used. The contrast was set to 60 (medium) and 300 (high) Hounsfield units. CT acquisitions were performed at three dose levels: 12, 9, and 6 mGy. Images were reconstructed via filtered back projection (FBP), DLIR, and HIR. The noise power spectrum (NPS) and task transfer function (TTF) were measured, and the system performance (SP) function was calculated (TTF 2 /NPS)., Results: The noise magnitudes at low spatial frequencies with DLIR and HIR were lower than that with FBP by 45.6% and 24.4%, respectively. Compared to the FBP results, the TTF values at 50% with DLIR at medium and high contrast changed by -13.2% and +25.3% with the VMS images and -2.0% and +9.3% with the 120 kVp images, respectively. In the VMS and 120 kVp images, compared to the SP values of 12 mGy FBP images, SP values of 6 mGy DLIR images decreased at medium contrast and increased at high contrast., Conclusions: DLIR achieved better noise reduction than HIR. The spatial resolution of VMS-DLIR varied significantly depending on the contrast. The image quality of VMS-DLIR and 120 kVp-DLIR potentially decrease in medium contrast tasks and increase in high contrast tasks with 50% dose reduction., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Serum albumin levels are inversely related with oxidative stress, but positively related with endothelial function, in pregnant women. However, it is unclear whether hypoalbuminemia in pregnant women with preeclampsia (PE) increases the production of oxygen-derived free radicals and impacts endothelial function. The present study aimed to assess the relationship between serum albumin, oxidative stress, and endothelial dysfunction in pregnant women with PE. A total of 75 women with control pregnancy (Control group, n = 30), PE (PE group, n = 24), or gestational hypertension (GH) (GH group, n = 21) were enrolled. We assessed serum albumin levels, diacron-reactive oxygen metabolites (d-ROMs) as an oxygen-derived free radical marker, and flow-mediated dilation (FMD) as a readout for vascular endothelial function during the gestational period and at one month after delivery. During the gestational period, FMD was lower, but d-ROM levels were higher, in the PE and GH groups compared with the Control group. Serum albumin levels were lower in the PE group compared with the Control and GH groups. d-ROM levels were inversely correlated with serum albumin levels (r = -0.54, p < 0.05) and FMD (r = -0.56, p < 0.05) in the PE group, and negatively correlated with FMD, but not serum albumin levels, in the GH group. Serum levels of d-ROMs and albumin, as well as FMD, were similar between groups after delivery. Our findings suggest that reduced serum albumin levels enhance the production of oxygen-derived free radicals, resulting in impaired maternal vascular endothelial function in parturients with PE., Competing Interests: HK is a consult of IMI Co. Ltd, Koshigaya, Saitama, Japan. Other authors declare no conflicts of interest in connection with this article.

Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract encompassing two main clinical entities, Crohn's disease and ulcerative colitis. Accumulated evidence indicates that an aberrant immune activation caused by the interplay of genetic susceptibility and environmental impact on the gut microbiota may be involved in the pathogenesis of IBD. Rapid advances in next-generation sequencing technology have enabled a number of studies to identify the alteration of the gut microbiota, termed dysbiosis, in IBD. Moreover, the alteration in the metabolites derived from the gut microbiota in IBD has also been described in many studies. Therefore, microbiota-based interventions such as fecal microbiota transplantation (FMT) have attracted attention as a novel therapeutic option in IBD. However, in clinical trials, the efficacy of FMT for IBD remains controversial. Additional basic and clinical studies are required to validate whether FMT can assume a complementary role in the treatment of IBD. The present review provides a synopsis on dysbiosis in IBD and on the association between the gut microbiota and the pathogenesis of IBD. In addition, we summarize the use of probiotics in IBD and the results of current clinical trials of FMT for IBD., Competing Interests: Conflict-of-interest statement: No conflict of interest., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: This study aimed to investigate the etiology and pathology of preeclampsia (PE), a two-stage disorder involving uteroplacental dysfunction resulting from abnormal implantation and placentation, and gestational hypertension (GH), for which maternal organic vascular disorder is often an underlying factor. Methods: We assessed concentrations of oxygen free radicals (d-ROMs), maternal angiogenic factor (PlGF), and antiangiogenic factor (sFlt-1), placental hypoxic changes, oxidative DNA damage, and maternal organic vascular disorders in 23 women with PE (PE group), 13 with GH (GH group), and 16 with uncomplicated pregnancies (normal group). Intima-media thickness (IMT) of the carotid artery was assessed as a proxy for maternal organ vascular disorder. Immunohistochemical analysis was performed to measure the proportion of placental trophoblast cell nuclei staining positive for hypoxia-inducible factor-1α (HIF-1α), which reflects hypoxic changes, and 8-hydroxy-2'-deoxyguanosine (8-OHdG), which reflects oxidative DNA damage. Results: Maternal serum d-ROM concentrations were significantly increased in both GH and PE groups relative to the normal group. Maternal serum d-ROM concentrations were significantly increased in both GH and PE groups relative to the normal group. Maternal serum sFlt-1 concentrations, ratio of sFlt-1/PlGF, and proportions of HIF-1α-positive nuclei and 8-OHdG-positive nuclei were significantly higher in the PE group compared to GH and normal groups. IMT was significantly greater in GH and PE groups compared to the normal group, and was higher in the GH group compared to the PE group. Conclusions: Our findings suggest that placental hypoxic changes and oxidative DNA damage are severe in patients with PE and accompanied by an increase in antiangiogenic factors. Moreover, maternal organ vascular disorder was more severe in patients with GH compared to those with PE, as assessed by IMT. Key message: PE is a two-stage disorder that involves uteroplacental dysfunction, and organic vascular disorder underlies GH.

A 66-year-old man with severe diarrhea and severe hypoproteinemia was referred for Tc-DTPA-human serum albumin (HSA-D) scintigraphy. The scintigraphy at 24 hours postinjection showed strong accumulation of Tc-HSA-D in not only the colon but also all his diapers containing his egested feces. The ratio of the diapers counts to the total counts was 17.0%, and a considerable amount of protein loss was confirmed. Tc-HSA-D scintigraphy has an important role in diagnosing protein-losing enteropathy, but the abdomen is the only routinely scanned area. Additional scanning of egested radiotracer and the whole body can be useful for evaluating the disease severity.

Background: Evidence has shown the clinical usefulness of measuring the metastatic tumor burden of bone for prognostic assessment especially in prostate cancer; quantitative evaluation by dedicated SPECT is difficult due to the lack of attenuation correction (AC) method. We developed a novel method for attenuation correction using bone SPECT emission data (bone SPECT-based segmented attenuation correction; B-SAC) where emission data were virtually segmented into three tissues (i.e., bone, soft tissue, and air). Then, the pixel values in SPECT were replaced by 50 for the virtual soft tissue, and - 1000 for the virtual air. The replaced pixel values for the virtual bone were based on the averaged CT values of the normal vertebrae (B-SAC N ) or the metastatic bones (B-SAC M ). Subsequently, the processed SPECT data (i.e., SPECT value) were supposed to realize CT data (i.e., CT value) that were used for B-SAC. The standardized uptake values (SUVs) of 112 metastatic bone tumors in 15 patients with prostate cancer were compared between CTAC with scatter correction (SC) and resolution recovery (RR) and the following reconstruction conditions: B-SAC N (+)SC(+)RR(+), B-SAC M (+)SC(+)RR(+), uniform AC(UAC)(+)SC(+)RR(+), AC(-)SC(+)RR(+), and no correction (NC)., Results: The SUVs in the five reconstruction conditions were all correlated with those in CTAC(+)SC(+)RR(+) (p < 0.01), and the correlations between B-SAC N or B-SAC M and CTAC images were excellent (r > 0.94). Bland-Altman analysis showed that the mean SUV differences between CTAC (+)SC(+)RR(+) and the other five reconstructions were 0.85 ± 2.25 for B-SAC N (+)SC(+)RR(+), 1.61 ± 2.36 for B-SAC M (+)SC(+)RR(+), 1.54 ± 3.84 for UAC(+)SC(+)RR(+), - 3.12 ± 4.97 for AC(-)SC(+)RR(+), and - 5.96 ± 4.59 for NC. Compared to CTAC(+)SC(+)RR(+), B-SAC N (+)SC(+)RR(+) showed a slight but constant overestimation (approximately 17%) of the metastatic tumor burden of bone when the same threshold of metabolic tumor volume was used., Conclusions: The results of this preliminary study suggest the potential for B-SAC to improve the quantitation of bone metastases in bone SPECT when X-ray CT or transmission CT data are not available. Considering the small but unignorable differences of lesional SUVs between CTAC and B-SAC, SUVs obtained with the current version of B-SAC seem difficult to be directly compared with those obtained with CTAC.

Objectives: Continuous bed motion (CBM) acquisition recently became available in whole-body PET/CT scanners in addition to the conventional step and shoot (S&S) acquisition. In this work, we compared the image quality between these acquisition methods using a phantom simulating periodic motion to mimic motion from patient breathing in a controlled manner., Methods: PET image quality was assessed using the National Electrical Manufacturers Association IQ torso phantom filled with an F-FDG solution using a 4 : 1 target-to-background ratio. The phantom was scanned in two states: no motion (stationary) and with periodic motion in the axial direction with a displacement ±10 mm from the initial position. Both S&S and CBM scans were repeated 10 times in an alternating order, whereby the acquisition duration of each scan was adjusted to make the true counts approximately comparable to compensate for the decaying F-FDG., Results: The recovery coefficient analysis showed that in the stationary state, the 10 mm sphere recovery did not show any difference between S&S and CBM. With motion, the recovery coefficient was lower by ∼40% for both modes of acquisition. In addition, the image-based volume analysis of the 10 mm sphere showed 1.67 (1.57-1.69) cm for S&S and 1.73 (1.66-1.83) cm for CBM (P=0.13), and there was no difference between two modes. Our study indicated that when the acquisition conditions for S&S and CBM (equivalent net trues, identical phantom motion, and identical CT image used for PET corrections) were controlled carefully, these acquisition modes resulted in equivalent image quality.

A 64-year-old man with castration-resistant prostate cancer received Ra injection to treat bone metastases. The patient underwent a Ra SPECT scan after the first Ra injection in which there was increased uptake all over the spine. Spine-to-background activity ratio in the patient was approximately three times greater than normal spine-to-background activity ratios in Ra SPECT obtained from the other patients. Eight days after the fifth injection, the patient exhibited a very poor neurologic examination and died of intracranial hemorrhage due to severe thrombocytopenia (platelet counts, 23,000/mm). The extensive radiation to the spine may have enhanced myelophthisic process in this case.

An 80-year-old man with castration-resistant prostate cancer received Ra injection to treat bone metastases. Two weeks after the injection, the patient underwent static Ra scan of the chest with medium-energy and high-energy collimators for 30 minutes each. Images obtained with the 2 collimators showed that uptake in metastatic lesions was visually clearer and semiquantitatively higher with the high-energy collimator. The use of HE collimator for Ra imaging in the early phase has been reported, and the present case suggests that in the late phase HE collimator would also be preferable to medium-energy collimator in terms of lesion-based evaluation.

Background: Although quantitative analysis using standardized uptake value (SUV) becomes realistic in clinical single-photon emission computed tomography/computed tomography (SPECT/CT) imaging, reconstruction parameter settings can deliver different quantitative results among different SPECT/CT systems. This study aims to propose a use of the digital reference object (DRO), which is a National Electrical Manufacturers Association (NEMA) phantom-like object developed by the Quantitative Imaging Biomarker Alliance (QIBA) fluorodeoxyglucose-positron emission tomography technical committee, for the purpose of harmonizing SUVs in Tc-99m SPECT/CT imaging., Methods: The NEMA body phantom with determined Tc-99m concentration was scanned with the four state-of-the-art SPECT/CT systems. SPECT data were reconstructed using different numbers of the product of subset and iteration numbers (SI) and the width of 3D Gaussian filter (3DGF). The mean (SUV mean ), maximal (SUV max ), and peak (SUV peak ) SUVs for six hot spheres (10, 13, 17, 22, 28, and 37 mm) were measured after converting SPECT count into SUV using Becquerel calibration factor. DRO smoothed by 3DGF with a FWHM of 17 mm (DRO 17 mm ) was generated, and the corresponding SUVs were measured. The reconstruction condition to yield the lowest root mean square error (RMSE) of SUV means for all the spheres between DRO 17 mm and actual phantom images was determined as the harmonized condition for each SPECT/CT scanner. Then, inter-scanner variability in all quantitative metrics was measured before (i.e., according to the manufacturers' recommendation or the policies of their own departments) and after harmonization., Results: RMSE was lowest in the following reconstruction conditions: SI of 100 and 3DGF of 13 mm for Brightview XCT, SI of 160 and 3DGF of 3 pixels for Discovery NM/CT, SI of 60 and 3DGF of 2 pixels for Infinia, and SI of 140 and 3DGF of 15 mm for Symbia. In pre-harmonized conditions, coefficient of variations (COVs) among the SPECT/CT systems were greater than 10% for all quantitative metrics in three of the spheres, SUV max and SUV mean , in one of the spheres. In contrast, all metrics except SUV max in the 17-mm sphere yielded less than 10% of COVs after harmonization., Conclusions: Our proposed method clearly reduced inter-scanner variability in SUVs. A digital phantom developed by QIBA would be useful for harmonizing SUVs in multicenter trials using SPECT/CT.

Background: Image-based measurement of absorbed dose of Ra-223 dichloride may be useful in predicting therapeutic outcome in patients with castration-resistant prostate cancer (CRPC). In general, SPECT has been found to be more accurate than planar imaging in terms of lesion-based analysis. The aims of this study were to assess the feasibility and clinical usefulness of Ra-223 SPECT. The energy spectrum of Ra-223 and SPECT images of a cylindrical phantom with a hot rod were obtained to determine the collimator candidates and energy window settings suitable for clinical Ra-223 SPECT (basic study A). Another phantom with a tube-shaped chamber and two spheres simulating bowel activity and metastatic lesions in the lumbar spine was scanned with medium-energy general-purpose (MEGP) and high-energy general-purpose (HEGP) collimators (basic study B). Ten patients with CRPC underwent SPECT imaging 2 h after Ra-223 injection successively with MEGP and HEGP collimators in random order for 30 min each. Lesion detectability and semi-quantitative analyses of bone metastasis (i.e. lesion-to-background ratio (LBR)) were performed compared to Tc-99m HMDP SPECT., Results: Basic study A revealed that an 84-keV photopeak ± 20% using the HEGP collimator offers better SPECT image quality than the other imaging conditions. Basic study B showed that uptake in one of the spheres was overestimated by overlapped activity of the tube-shaped chamber in planar imaging whereas the spheres had similar counts and significantly higher sphere-to-background ratio in SPECT. On both planar and SPECT images, HEGP gave higher image contrast than MEGP (p < 0.01). In the clinical study, Ra-223 SPECT at 84 keV ± 20% depicted more lesions with the HEGP than with the MEGP collimator (51 vs 36, p = 0.013). There was a positive correlation between LBR in Tc-99m SPECT and in Ra-223 SPECT (r = 0.67 with the MEGP and 0.69 with the HEGP collimator, p < 0.01). LBRs were significantly higher with the HEGP than with the MEGP collimator (p < 0.01)., Conclusions: We recommended the use of the HEGP collimator at 84 keV ± 20% for Ra-223 SPECT imaging. Lesion-based semi-quantitative analysis in the human study revealed a good correlation between Ra-223 and Tc-99m HMDP SPECT in the early phase (2-3 h post injection).

Strontium-89 (Sr-89) chloride is a targeted palliative therapy used for painful bone metastasis in which repeated doses can be administered, and its usefulness has been reported in the case of bone metastasis of various primary tumors. However, the effectiveness of the pain relief treatment is only described using a subjective index such as the visual analog scale, which lacks objectivity. Although various attempts at quantifying the effectiveness of Sr-89 chloride therapy have been reported using nuclear medicine imaging for energy peaks around 70-80 keV, the principle of Sr-89 chloride imaging has not been explained. In this study, the principle of nuclear medicine imaging for Sr-89 chloride was evaluated using a fundamental study. Additionally, the optimal collimator for acquiring Sr-89 chloride image data was evaluated. Based on the results, the principle of nuclear medicine imaging for Sr-89 chloride could be explained: the energy peaks were characteristic X-rays produced by interactions between gamma rays (514 keV) emitted from Sr-85, which is included during the manufacturing process of the Sr-89 chloride solution, and the lead collimator used in the imaging. The optimal collimator for generating characteristic X-rays efficiently was identified as a middle-to-high energy collimator.

Purpose: The purpose of this study was to investigate the protective effects of sodium hyaluronate eyedrop against corneal epithelial disorders caused by antiglaucomatous eyedrops using an electrophysiological method., Methods: Three kinds of antiglaucomatous eyedrops, including benzalkonium chloride (BAC) as an ophthalmic preservative, a BAC-free antiglaucomatous eyedrop, and a sodium hyaluronate eyedrop, were used in this study. Eyedrops were applied to excised rabbit corneas, and the electrophysiological property of the cornea was monitored using an Ussing chamber with a turnover system that mimics human tear turnover. With this system, changes in transepithelial electrical resistance (TER) in the corneal surface were recorded., Results: The corneal TER after applying antiglaucomatous eyedrops tended to decrease concomitantly with increasing the concentration of the BAC included as a preservative. On the other hand, there was no significant change in the corneal TER for the initial 60 min after applying sodium hyaluronate eyedrop compared with those of the control. Moreover, the pretreatment with a sodium hyaluronate eyedrop reduced the extent of decrease in the corneal TER observed after application of antiglaucomatous eyedrops alone., Conclusion: Those results indicate that a sodium hyaluronate eyedrop has the potential to protect the corneal surface from antiglaucomatous eyedrops, including BAC as an ophthalmic preservative.

We treated a patient with undifferentiated carcinoma of the lung, with osteoclast-like giant cells resembling those of the giant cell tumor of bone. The clinical and morphologic characteristics of this case are documented, and the literature concerning this type of tumor is reviewed. The tumor differed histologically from the pleomorphic carcinoma, which occurs most commonly in the lung, and showed diverse pleomorphic manifestation with benign looking osteoclast-like multinucleated cells and bizarre giant cells. In addition, and undifferentiated carcinoma with a sarcoma-like appearance containing small areas of papillary adenocarcinoma was evident in the tumor.