Myosteatosis is associated with coronary artery calcification in patients with type 2 diabetes

BACKGROUND Myosteatosis,rather than low muscle mass,is the primary etiologic factor of sarcopenia in patients with type 2 diabetes mellitus(T2DM).Myosteatosis may lead to a series of metabolic dysfunctions,such as insulin resistance,systematic inflammation,and oxidative stress,and all these dysfunctions are closely associated with the acceleration of T2DM and atherosclerosis.AIM To investigate the association between myosteatosis and coronary artery calcification(CAC)in patients with T2DM.METHODS Patients with T2DM,who had not experienced major cardiovascular events and had undergone both abdominal and thoracic computed tomography(CT)scans,were included.The mean skeletal muscle attenuation was assessed using abdominal CT images at the L3 level.The CAC score was determined from thoracic CT images using the Agatston scoring method.Myosteatosis was diagnosed according to Martin’s criteria.Severe CAC(SCAC)was defined when the CAC score exceeded 300.Logistic regression and decision tree analyses were performed.RESULTS A total of 652 patients with T2DM were enrolled.Among them,167(25.6%)patients had SCAC.Logistic regression analysis demonstrated that myosteatosis,age,duration of diabetes,cigarette smoking,and alcohol consumption were independent risk factors of SCAC.Myosteatosis was significantly associated with an increased risk of SCAC(OR=2.381,P=0.003).The association between myosteatosis and SCAC was significant in the younger patients(OR=2.672,95%CI:1.477-4.834,P=0.002),but not the older patients(OR=1.456,95%CI:0.863-2.455,P=0.188),and was more prominent in the population with lower risks of atherosclerosis.The decision tree analyses prioritized older age as the primary variable for SCAC.In older patients,cigarette smoking was the main contributing factor for SCAC,while in younger patients,it was myosteatosis.CONCLUSION Myosteatosis is a novel risk factor for atherosclerosis in patients with T2DM,especially in the population with younger ages and fewer traditional risk factors.

Current understanding of coronary artery calcification

Coronary artery calcification （CAC） is highly prevalent in patients with coronary heart disease （CHD） and is associated with major adverse cardiovascular events. There are two recognized type of CAC--intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcification is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven- tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD pa- tients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.

Association between serum cartilage oligomeric matrix protein and coronary artery calcification in maintenance hemodialysis patients

Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.

Ideal Cardiovascular Health Metrics and Coronary Artery Calcification in Northern Chinese Population:A Cross-sectional Study

Objective Coronary artery calcification（CAC） is a well-established risk predictor of coronary heart disease events and is recognized as an indicator of subclinical atherosclerosis.Methods A cross-sectional study consisting of 2999 participants aged ≥40 years from the Jidong community of Tangshan City,an industrial and modern city of China,was conducted between 2013 and 2014 to examine the association between the ideal cardiovascular health（CVH） metrics and CAC.The ideal CVH metrics were determined based on the definition of the American Heart Association（AHA）.The participants were then grouped into 4 categories according to the quartiles of their CVH metric scores as follows：first quartile（0-2）,second quartile（3）,third quartile（4）,and fourth quartile（5-7）.CAC was assessed by using high-pitch dual-source CT,and patients were identified based on thresholds of 0,10,100,or 400 Agatston units,as per common practice.Results The prevalence of subclinical atherosclerosis was 15.92%,13.85%,6.76%,and 1.93%,determined by using the CAC scores at thresholds of 0,10,100,and 400 Agatston units,respectively.Compared with the group in the first quartile,the other three CVH groups had a lower odds ratio of CAC 0 after adjusting for age,sex,income level,education level,and alcohol use in the logistic regression analysis.The odds ratios in these groups were 0.86 [95% confidence interval（CI）,0.63-1.17;P0.05],0.75（95% CI,0.55-1.02;P0.05）,and 0.49（95% CI,0.35-0.69;P0.05）,respectively.These associations of CAC with the CVH metrics were consistent when different CAC cutoff scores were used（0,10,100,or 400）.Conclusion The participants with more-ideal cardiovascular metrics had a lower prevalence of subclinical atherosclerosis determined according to CAC score.Maintaining an ideal cardiovascular health may be valuable in the prevention of atherosclerosis in the general population.

Enhanced Wolf Pack Algorithm (EWPA) and Dense-kUNet Segmentation for Arterial Calcifications in Mammograms

Breast Arterial Calcification(BAC)is a mammographic decision dissimilar to cancer and commonly observed in elderly women.Thus identifying BAC could provide an expense,and be inaccurate.Recently Deep Learning(DL)methods have been introduced for automatic BAC detection and quantification with increased accuracy.Previously,classification with deep learning had reached higher efficiency,but designing the structure of DL proved to be an extremely challenging task due to overfitting models.It also is not able to capture the patterns and irregularities presented in the images.To solve the overfitting problem,an optimal feature set has been formed by Enhanced Wolf Pack Algorithm(EWPA),and their irregularities are identified by Dense-kUNet segmentation.In this paper,Dense-kUNet for segmentation and optimal feature has been introduced for classification(severe,mild,light)that integrates DenseUNet and kU-Net.Longer bound links exist among adjacent modules,allowing relatively rough data to be sent to the following component and assisting the system in finding higher qualities.The major contribution of the work is to design the best features selected by Enhanced Wolf Pack Algorithm(EWPA),and Modified Support Vector Machine(MSVM)based learning for classification.k-Dense-UNet is introduced which combines the procedure of Dense-UNet and kU-Net for image segmentation.Longer bound associations occur among nearby sections,allowing relatively granular data to be sent to the next subsystem and benefiting the system in recognizing smaller characteristics.The proposed techniques and the performance are tested using several types of analysis techniques 826 filled digitized mammography.The proposed method achieved the highest precision,recall,F-measure,and accuracy of 84.4333%,84.5333%,84.4833%,and 86.8667%when compared to other methods on the Digital Database for Screening Mammography(DDSM).

Metabolic syndrome and coronary artery calcification： a community-based natural population study

Background Little is known about the influence of metabolic syndrome （MetS） on coronary artery calcification （CAC） in China. In this article, we aimed to explore the distribution of CAC in populations with and without MetS, and estimate the influence of MetS and its components on CAC in a community-based population of Beijing. Methods A total of 1647 local residents of Beijing, age 40-77 years, were recruited for a cardiovascular risk factors survey and were determined fasting plasma glucose （FPG）, blood lipids, and 64 multi-detector computed tomography （64-MDCT） coronary artery calcium score （CACS） measurement （Agatston scoring）. The distribution of CAC was described, and the influence of MetS components on CAC was evaluated. Results In this population, the prevalence and extent of CAC increased with increasing age and both were higher in MetS subjects compared to nonMetS subjects （all P 〈0.05）, with the exception of those older than 65 years old. The risk of CAC increased with increasing numbers of MetS components, and the odds ratios for predicting positive CAC in subjects with 1, 2, 3, and 〉4 MetS components were 1.60, 1.84, 2.12, and 3.12, respectively （all P 〈0.05）. Elevated blood pressure, elevated FPG, elevated triglycerides, and overweight increased the risk of CAC, yielding odds ratios of 2.64, 1.67, 1.32, and 1.37, respectively （all P 〈0.05）. Conclusions In the Beijing community-based population, MetS increases the risk of CAC. The risk of CAC increases with increasing numbers of MetS components. Not only the number, but also the variety of risk factors for MetS is correlated with the risk of CAC. Elevated blood pressure, hyperglycemia, hypertriglyceridemia and overweight increase the risk of CAC.

Coronary artery calcification is associated with atherogenic lipid changes, cardiac dysfunction and morphologic abnormalities in HIV-1 infected black adults

The heart is an organ frequently affected in the acquired immunodeficiency syndrome.~1 But there is little information as to whether the coronary artery calcification can identify asymptomatic individuals at high risk for having cardiac morphological and functional abnormalities and cardiac risk factors in human immunodeficiency virus (HIV)-infected persons. Accordingly, the purpose of this study was to determine whether coronary artery calcification was associated with cardiac morphological and functional abnormalities, atherogenic lipid and C-reactive protein (CRP) changes in a black adult population with HIV-1 infection.

Altered serum level of cartilage oligomeric matrix protein and its association with coronary calcification in patients with coronary heart disease

Background Cartilage oligomeric matrix protein （COMP） is mainly found in the skeletal system and vascular smooth muscle cells. Recent researches showed that it had a protective function on blood vessels and could also inhibit vascular calcification. We investigated the serum COMPs in coronary heart disease （CHD） patients, and the relationship between serum COMP and the calcification of coronary artery. Methods A total of 233 consecutive chest pain patients who first underwent coronary angiography followed by multi-slice computed to- mography （MSCT） within six months were recruited and divided into two groups according to the coronary angiography luminal diameter narrowing percentages： CHD group （diameter narrowing 〉 50%, n = 194） and control group （diameter narrowing 〈 50%, n = 39）. The Gen- sini score, Syntax score and coronary artery calcium score （CACs） were calculated. The serum COMP level was determined using ELISA. Results The levels of COMP were significantly higher in the CHD group than in the control group 155.7 （124.5-194.5） ng/mL vs. 128.4 （113.0-159.9） ng/mL, P = 0.019. There were no correlation between COMP, Gensini score, Syntax score, severity of coronary stenosis and the number of coronary artery with stenosis 〉 50%. The serum COMP was correlated with age （r = 0.294, P 〈 0.001）, fasting glucose （r = 0.163, P = 0.015）, HbAlc （r = 0.194, P = 0.015） and CACs （r = 0.137, P = 0.037）. Stepwise linear regression analysis showed that COMP level and age were independent predictors of CACs in the CHD patients （fl = 0.402, t = 2.612, P = 0.015; fl = 0.472, t = 3.077, P = 0.005）. Performance of COMP for predicting CHD was shown as area under curve （AUC）： 0.632, 95% CI： 0.549-0.715 and upper tertile CACs was AUC： 0.602, 95% CI： 0.5264）.678 in receiver operating characteristic （ROC） curve analysis. Conclusion Calcification of coronary artery was an independent predictor of serum COMPs.

Coronary artery disease in Chinese adults with type 2 diabetes mellitus estimated by electron beam computed tomography and electron beam computed tomography angiography

Objective To assess the prevalence and risk of coronary artery disease(CAD)in Chinese adults with type 2 diabetes mellitus(T2DM)using electron beam computed tomography(EBCT)and EBCT angiography(EBCTA).Methods:Ninety-four cases were enrolled in this study including diabetes(n=28),impaired glucose tolerance(IGT,n=30),coronary heart disease(CHD,n=11),and control(n=25).Cardiac EBCT plain scanning and EBCTA were performed on all of these subjects to evaluate coronary artery calcifica-tion(CAC)scores,and number of segments of stenosed coronary arteries.Both CAC and/or coronary artery stenosis were defined as patients with coronary artery lesions(CAL).Results CAC scores were not different with the control,diabetes,IGT,or CHD(P>0.05)groups.Compared to control(0.520±1.295),more stenosed coronary arteries segments(P<0.05)were detected in diabetes(2.964±1.915),IGT(2.200±2.024),and CHD(2.273±1.679).Number of stenosed artery segments were correlated with age(r=0.215,P=0.019),postprandial glucose(r=0.224,P=0.015),total cholesterol(r=0.323,P=0.000),and duration of diabetes(r=0.208,P=0.004).The incidences of CAL in diabetes(96.43%),IGT(93.33%),and CHD(90.91%)was substantially higher than that in normal control(56.00%,P<0.01).The odds ratio of CAL associated with having diabetes was estimated to be 7.514(95%CI:1.885-63.778).Conclusions Coronary artery lesions are prevalent in Chinese adults with type 2 diabetes,implying a high CAD risk.EBCTA holds potential in depicting the details of CAL and can be used to track the progression of CAD in diabetes patients.

Findings on intraprocedural non-contrast computed tomographic imaging following hepatic artery embolization are associated with development of contrast-induced nephropathy

BACKGROUND Contrast-induced nephropathy(CIN)is a reversible form of acute kidney injury that occurs within 48-72 h of exposure to intravascular contrast material.CIN is the third leading cause of hospital-acquired acute kidney injury and accounts for 12%of such cases.Risk factors for CIN development can be divided into patientand procedure-related.The former includes pre-existing chronic renal insufficiency and diabetes mellitus.The latter includes high contrast volume and repeated exposure over 72 h.The incidence of CIN is relatively low(up to 5%)in patients with intact renal function.However,in patients with known chronic renal insufficiency,the incidence can reach up to 27%.AIM To examine the association between renal enhancement pattern on non-contrast enhanced computed tomographic(CT)images obtained immediately following hepatic artery embolization with development of CIN.METHODS Retrospective review of all patients who underwent hepatic artery embolization between 01/2010 and 01/2011(n=162)was performed.Patients without intraprocedural CT imaging(n=51),combined embolization/ablation(n=6)and those with chronic kidney disease(n=21)were excluded.The study group comprised of 84 patients with 106 procedures.CIN was defined as 25%increase above baseline serum creatinine or absolute increase≥0.5 mg/dL within 72 h post-embolization.Post-embolization CT was reviewed for renal enhancement patterns and presence of renal artery calcifications.The association between noncontrast CT findings and CIN development was examined by Fisher’s Exact Test.RESULTS CIN occurred in 11/106(10.3%)procedures(Group A,n=10).The renal enhancement pattern in patients who did not experience CIN(Group B,n=74 with 95/106 procedures)was late excretory in 93/95(98%)and early excretory(EE)in 2/95(2%).However,in Group A,there was a significantly higher rate of EE pattern(6/11,55%)compared to late excretory pattern(5/11)(P<0.001).A significantly higher percentage of patients that developed CIN had renal artery calcifications(6/11 vs 20/95,55%vs 21%,P=0.02).CONCLUSION A hyperdense renal parenchyma relative to surrounding skeletal muscle(EE pattern)and presence of renal artery calcifications on immediate post-HAE noncontrast CT images in patients with low risk for CIN are independently associated with CIN development.

Arterial calcification: Finger-pointing at resident and circulating stem cells

The term "Stammzelle"(stem cells) originally appeared in 1868 in the works of Ernst Haeckel who used it to describe the ancestor unicellular organism from which he presumed all multicellular organisms evolved. Since then stem cells have been studied in a wide spectrum of normal and pathological conditions; it is remarkable to note that ectopic arterial calcification was considered a passive deposit of calcium since its original discovering in 1877; in the last decades, resident and circulating stem cells were imaged to drive arterial calcification through chondro-osteogenic differentiation thus opening the idea that an active mechanism could be at the basis of the process that clinically shows a Janus effect: calcifications either lead to the stabilization or rupture of the atherosclerotic plaques. A review of the literature underlines that 130 years after stem cell discovery, antigenic markers of stem cells are still debated and the identification of the osteoprogenitor phenotype is even more elusive due to tissue degradation occurring at processing and manipulation. It is necessary to find a consensus to perform comparable studies that implies phenotypic recognition of stem cells antigens. A hypothesis is based on the singular morphology and amitotic mechanism of division of osteoclasts: it constitutes the opening to a new approach on osteoprogenitors markers and recognition. Our aim was to highlight all the present evidences of the active calcification process, summarize the different cellular types involved, and discuss a novel approach to discover osteoprogenitor phenotypes in arterial wall.

Intravascular lithotripsy for coronary calcium:A case report and review of the literature

BACKGROUND Coronary calcium poses a challenge for the interventional cardiologist often leading to stent under-expansion and subsequent ischemic events.Aggressive balloon post-dilatation though helpful is usually inadequate.Multiple plaque ablation techniques are in vogue,but they are technically demanding and are not without complications.Shockwave intravascular lithotripsy(S-IVL)has emerged as a user-friendly and effective mechanism for calcium management with a high safety margin.A series of trials(DISRUPT CAD I-IV)have demonstrated both short-term and long-term safety and efficacy of the technique.As experience with the technique grows more and more,therapy areas like stent restenosis are being covered by the S-IVL.CASE SUMMARY We report a series of 2 cases successfully managed with S-IVL therapy at our center.The first case is of a 57-year-old smoker who presented with acute coronary syndrome.His left anterior descending coronary artery revealed calcified 90%stenosis on angiogram and a combination of superficial-deep calcium on intracoronary imaging.The calcium was treated with 20 pulses of S-IVL to create discontinuity and a sirolimus eluting drug-eluting stent was successfully implanted.The second case is that of an elderly lady who presented with stable angina and demonstrated diffuse calcified lesions in the left anterior descending artery on angiogram.She also demonstrated a mixture of superficial and deep seated calcium zones on imaging.S-IVL therapy was applied to generate fractures in calcium,and two overlapping drug-eluting stents were implanted successfully without any complications.CONCLUSION S-IVL is an emerging,efficient,user-friendly and safe therapy for managing intracoronary calcium in routine interventional practice.

Implication of Receptor Activator of NF-κB Ligand in Wnt/β-Catenin Pathway Promoting Osteoblast-like Cell Differentiation

Recent studies showed that activation of Wnt/β-catenin pathway promoted the differentiation of osteoblast-like cells in the arterial calcification, but its mechanism remains unknown. In this study, the hypothesis that Wnt/β-catenin pathway promotes the differentiation of osteoblast-like cells by upregulating the expression of receptor activator of NF-κB ligand (RANKL) was examined. LiCl was used to activate the Wnt/β-catenin pathway. The differentiation of osteoblast-like cells was observed by Von Kossa staining, calcium content assay, alkaline phosphatase (ALP) activity assay, and detection of osteocalcin expression. Real-time PCR was performed to detect the expression of RANKL and osteoprotegerin (OPG, the decoy receptor of RANKL) during the osteoblast-like cell differentiation. Different concentrations of OPG were added to the culture media respectively to inhibit the function of RANKL, and the change in the differentiation of osteoblast-like cells was evaluated. The results showed that when the Wnt/β-catenin pathway was activated by LiCl, the expression of RANKL was significantly in-creased, which coincided with the differentiation of osteoblast-like cells (P<0.05), and the OPG treatment could partly attenuate the promoting effect of Wnt/β-catenin pathway on the differentiation of osteoblast-like cells (P<0.05), but it failed to completely abolish such effect. It was concluded that activation of Wnt/β-catenin pathway promotes the differentiation of osteoblast-like cells by both RANKL-dependent and RANKL-independent mechanisms.

Oxidized phospholipids and lipoprotein-associated phospholipase A_2 as important determinants of Lp(a) functionality and pathophysiological role

Lipoprotein（a） [Lp（a）] is composed of a low density lipoprotein（LDL）-like particle to which apolipoprotein（a）[apo（a）] is linked by a single disulfide bridge. Lp（a） is considered a causal risk factor for ischemic cardiovascular disease（CVD） and calcific aortic valve stenosis（CAVS）. The evidence for a causal role of Lp（a） in CVD and CAVS is based on data from large epidemiological databases, mendelian randomization studies, and genome-wide association studies. Despite the well-established role of Lp（a） as a causal risk factor for CVD and CAVS, the underlying mechanisms are not well understood. A key role in the Lp（a） functionality may be played by its oxidized phospholipids（OxPL） content. Importantly, most of circulating OxPL are associated with Lp（a）; however, the underlying mechanisms leading to this preferential sequestration of OxPL on Lp（a） over the other lipoproteins,are mostly unknown. Several studies support the hypothesis that the risk of Lp（a） is primarily driven by its OxPL content.An important role in Lp（a） functionality may be played by the lipoprotein-associated phospholipase A_2（Lp-PLA_2）,an enzyme that catalyzes the degradation of OxPL and is bound to plasma lipoproteins including Lp（a）. The present review article discusses new data on the pathophysiological role of Lp（a） and particularly focuses on the functional role of OxPL and Lp-PLA_2 associated with Lp（a）.

Relationship between breast arterial calcification on mammography with coronary CT angiography findings

BACKGROUND： Breast arterial calcification is a frequently benign finding on mammography that usually is not reported. An increasing attention has been formed to determine the association between breast arterial calcification （BAC） and Coronary artery disease. In the current study we have aimed to evaluate the relationship between BAC on mammography with coronary CT angiography findings. METHODS： The case control study was carried out on 60 women; 30 CAD and 30 healthy subjects as control, admitted to Golestan hospital radiology department. The mammography was performed in two views; Craniocaudal （CC） view and mediolateral oblique （MLO） and BAC was graded based on the severity and extent of calcifications. Coronary Arterial Calcification （CAC） were scored by Agatston criteria. RESULTS： Overly, 36 patients （60%） were positive for BAC. Twenty six out of them （72%） were CAD. There was a positive significant correlation between BAC and CAD. The sensitivity and specificity of BAC for CAD were 69% and 47%, respectively. Moreover, the severe BAC scores were significantly higher in CAD patients than non-CAD. CONCLUSION： Our findings in line with several previous studies indicated the positive significant association between BAC and CAD occurrence. While the sensitivity and specificity of BAC in diagnosis of CAD is low, suggested the using of BAC just as a CAD risk factor. The relatively low sample size is the major limitation of the study.

Manifestation of lower extremity atherosclerosis in diabetic patients with high ankle-brachial index

Background The ankle brachial index （ABI） is a simple, inexpensive, noninvasive tool that correlates well with angiographic disease severity and functional symptoms. The aim of this study was to identify the manifestation of lower extremity atherosclerotic lesions in patients with high ABI by retrospective clinical study.Methods A cohort of 184 diabetic patients, （63±14） years old, 144 males, who underwent simultaneously ABI testing and low extremity arterial duplex ultrasound within one week, were enrolled randomly into this study. According to the ABI value, they were divided into three groups： the high, normal and low ABI groups. The severity and location of atherosclerotic lesions in the lower extremity were determined based on the results of low extremity artery duplex ultrasound. The chi-square test was used to compare the atherosclerosis severity grade and lesion location across the three groups.Results The prevalence of low extremity artery occlusion was significantly lower in the high ABI group than in the low ABI group （3.3% vs. 63.5%, P〈0.01）, and the main atherosclerotic lesions were diffuse dot-like hyperechogenicity spots or small plaques （86.7%）. In addition, the atherosclerotic lesions were mostly found in the distal segment of the lower extremity in patients with high ABI （46.3%）.Conclusion A high ABI may be an integrative marker for intimal and medial calcification, which has a high positive predictive value for artery calcification.

Factors Predicting Late Rectal Disorders after Radiation Therapy for Prostate Cancer

Background： Although various studies have been conducted on the effects of radiation therapy for prostate cancer, rectal toxicity after radiation therapy for prostate cancer, which is an important late adverse event associated with radiation therapy, has not been sufficiently examined. This study aimed to assess the associations of late rectal disorder （LRD） with dosimetric, anatomic, and clinical factors in patients with prostate cancer who underwent three-dimensional conformal radiation therapy （3D-CRT）. Methods： We retrospectively analyzed 104 patients undergoing 3D-CRT between January 2009 and October 2011. Thirty patients were administered anticoagulation/antiplatelet （AC/AP） agents. The standard dose was 74 Gy. Uni- and multi-va,iate analyses we,e performed to identify factors predictive of LRD after 3D-CRT. Results： The median follow-up period was 66 （range： 14 87） months. LRD occurred in 10.6% （11/104） of patients. The median time fi＇om RT to LRD was 15 months （range： 7MI months）. Sixty-four percent of those with LRD （7/11 patients） had been given AC/AP agents. Fitly-five （6/11 ） patients had severe internal iliac artery calcification. By univariate analysis, significant predictors of LRD were internal iliac artery calcification, administration of AC/AP agents, and age. Being very elderly was the significant predictor identified by multivariate analysis （P = 0.0276）. For patients receiving AC/AP agents and those with severe internal iliac artery calcification, the LRD incidences were 23.3% （7/30 patients） and 23.1% （6/26 patients）, respectively, and being 75 years of age or older was a significant predictor in these subsets. Conclusions： Our results suggest advanced age, administration of AC/AP agents, and severe internal iliac artery calcification to be risk factors tbr LRD in patients undergoing standard RT. Therefore, it is necessary to administer radiation with particular caution in the very elderly, especially those receiving AC/AP agents and/or with severe internal iliac artery calcification.