Increased Sylvian fissure angle as early sonographic sign of malformation of cortical development

OBJECTIVE

To evaluate Sylvian fissure development by assessing Sylvian fissure angles in fetuses with malformation of cortical development (MCD).

METHODS

This was a retrospective study of 22 fetuses with MCD. Cases with a stored three-dimensional (3D) brain volume acquired at 18 + 0 to 30 + 6 weeks of gestation at an ultrasound-based research clinic between January 2010 and December 2017 were identified through a database. Of the 22 fetuses, seven had an extracranial abnormality, such as cardiac, renal, gastrointestinal and/or digital anomalies, and five had a minor abnormality such as micrognathia, low-set ears and/or single umbilical artery. To confirm the final clinical diagnosis of brain abnormality, postmortem histological findings or prenatal or postnatal magnetic resonance images were used. For measurement of Sylvian fissure angle, an anterior coronal plane of the fetal brain on transvaginal 3D volume multiplanar imaging was visualized as a single image from the three orthogonal views. The right and left Sylvian fissure angles were measured between a horizontal reference line (0°) and a line drawn along the upper side of the respective Sylvian fissure. The Sylvian fissure angle on both sides was plotted on the graphs of the reference ranges for gestational age in weeks.

RESULTS

In 21 (95.5%; 95% CI, 86.8-100.0%) of 22 fetuses with MCD, the Sylvian fissure angle on one or both sides was larger than the 90^th percentile of the normal reference. There was one case with apparent focal MCD in the parietal lobe, but the Sylvian fissure angles were normal. A case with apparent unilateral cortical dysplasia and one with apparent unilateral schizencephaly had conspicuous discrepancies between the left and right Sylvian fissure angles. Abnormal genetic test results were obtained in six cases, including four cases with a mutation in a single gene.

CONCLUSIONS

This study has shown that the Sylvian fissures, as defined by the Sylvian fissure angle, have delayed development in most MCD cases prior to the diagnosis of the condition. The Sylvian fissure angle may potentially be a strong indicator for the subsequent development of cortical malformation, before the time point at which the gyri and sulci become obvious on the fetal brain surface. Further research is required to validate these findings. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Abstract P4-06-06: Comparison of the immunological and clinical effect of personalized peptide vaccination for patients with breast cancer

Background: Selected therapeutic personalized peptide vaccines (PPV) were effective for boosting anticancer immune response that was associated with the clinical outcome as a prognostic factor for metastatic recurrent breast cancer (mrBC) 1-2. In this study, we investigated the immunological and clinical effect of PPV as the prophylactic cancer vaccine for non-recurrent but high-risk BC (nrhrBC) patients (pts), and we compared it's features to those of the mrBC pts who had active cancers or became resistant to the standard therapies(TR-mrBC). Methods: Material and Patient eligibility criteria: The peptides were selected from the 31 PPVs according to the results of HLA typing and peptide-specific IgG titers. Pts with a histological diagnosis of BC and their HLA-A molecules should be each of -A2, A3, A11, A24, A26, A31 or A33. The clinical protocols were approved by the institutional review board. (UMIN000003081and 00000184400000). Treatment schedule: A maximum of 4 peptides was administrated as weekly for initial four vaccinations and as biweekly for further inoculations. The concomitant standard endocrine therapy and the chemo-endocrine therapy were available for nrhrBC pts after finishing the standard adjuvant chemotherapy, and for mrBC pts concurrently. Immune and clinical response assessment: Specific T-cell responses, IgG titers and cytokines were evaluated using by interferon (IFN)-γ ELISPOT, Luminex assay and ELISA system in every 6-8 vaccinations. Toxicity, clinical response and correlation with the immune responses were investigated. Results: 16 pts with nrhrBC, 41 pts with mrBC and 79 pts with TR-mrBC received median 18, 16 and 14 vaccines, respectively. After PPV therapies, peptide-specific IgG and CTLs increased significantly in a total of 47 (77%) and 37(60%) in nrhrBC pts, 102 (63%) and 98 (61%) in mrBC pts, and 150(53%) and 100 (42%) in TR-mrBC pts. Pts experienced Grade 1-3 skin reaction at injection site, no other grade 3 or 4 SAEs were associated with PPV but with the disease progression or combination therapy. The median time to progression (TTP) and overall survival (OS) were not reached in nrhrBC pts, 7.8 and 29 months in mrBC pts, and were 7.5 and 15.9 months in TR-mrBC pts, respectively. The peptide specific CTL response was correlated significantly with OS in nrhrBC pts and the IgG levels were associated with the better OS in either non TR-mrBC pts or TR-mrBC pts. High levels of IL-6, GM-CSF, IFN-g, IL-2 receptor, BAFF were associated with worse prognosis for pts with TR-mrBC. And high levels of GM-CSF and BAFF were associated with worse prognosis for pts with nrhrBC and mrBC, respectively. In contrast, High levels of IL-2 were associated with the better prognosis for pts with mrBC. Conclusion: This study indicated that immunological features of these three groups were different from each other with most potent PPV-induced immune boosting for nrhrBC pts. Pts with mrBC who had lower immune-suppressive cytokine levels had the better prognosis. These results suggested the PPV therapy could be effective for postoperative prophylactic vaccination in patients with nrhrBC. References: 1. Takahashi R, Toh U, et al. Breast Cancer Res. 2014; 2. Toh U, Okabe M, et al. THE BREAST 2015.

Citation Format: Toh U, Okabe M, Takao Y, Tanaka Y, Shigaki T, Takenaka M, Iwakuma N, Sudo T, Yamada A, Shichijo S, Itoh K, Akagi Y. Comparison of the immunological and clinical effect of personalized peptide vaccination for patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-06-06.

Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial

Objectives/Hypothesis

Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost‐effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost‐effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene.

Study Design

Multicenter randomized controlled trial.

Methods

Patients who visited a National Hospital Organization (NHO) hospital for the surgical indication of hoarseness were included in the study. Before undergoing surgery, 200 patients with benign vocal fold lesions (vocal fold polyps/nodules) were enrolled and randomly allocated to the NHO‐style vocal hygiene educational program (intervention group) or control education program (control group). Two months after enrollment, the patients in both groups underwent laryngeal fiberscopic examinations to determine whether the benign lesions had resolved or whether surgery was indicated for the vocal fold polyps/nodules.

Results

After 2 months, in the intervention group, the proportion of lesion resolution (61.3%) was significantly greater than that in the control group (26.3%) (P < .001, Fisher exact test).

Conclusions

Our results clearly indicate that the quality and features of the education program could affect the outcome of the intervention. We found that a reinforced vocal hygiene education program increased the rate of the resolution of benign vocal fold polyps and nodules in a multicenter randomized clinical trial.

Level of Evidence

1b Laryngoscope, 2593–2599, 2018

Anti-neutrophil cytoplasmic antibody-associated glomerulonephritis with detection of myeloperoxidase and phospholipase A2 receptor in membranous nephropathy-lesions: report of two patients with microscopic polyangiitis

Background

Podocyte phospholipase A₂ receptor (PLA₂R) is a major target antigen in idiopathic adult membranous nephropathy (MN). Histological PLA₂R staining in the renal tissue has proven to be useful for the detection of idiopathic MN. However, glomerular PLA₂R deposits have also been recently observed in several patients with secondary MN, such as hepatitis B virus-associated, hepatitis C virus-associated, and neoplasm-associated MN. Certain inflammatory environments have been suggested to lead to abnormal expression of PLA₂R epitopes, with the resulting production of PLA₂R autoantibodies.

Case presentation

We report two patients diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis with MN-lesions, in whom ANCA titers for myeloperoxidase (MPO) were persistently positive. The first patient was a 52-years-old man who presented with interstitial pneumonitis. Microscopic hematuria and proteinuria were found when the interstitial pneumonitis became more severe. Renal biopsy findings yielded a diagnosis of ANCA-associated glomerulonephritis (mixed class) with MN-lesions. The second patient was a 63-years-old woman who had been treated for relapsing polychondritis. Her renal tissue showed evidence of focal ANCA-associated glomerulonephritis with MN-lesions. Interestingly, both MPO and PLA₂R were detected in the glomerular subepithelial deposits of both patients. Immunoglobulin G (IgG) 1 and IgG2 were positive in the glomeruli of patient 2, and all subclasses of IgGs were positive in patient 1.

Conclusion

The present cases suggest that ANCA-associated glomerulonephritis could expose PLA₂R, leading to the development of MN-lesions.

Abstract P3-05-09: Prognostic factors for therapeutic personalized peptide vaccines in patients with metastatic recurrent breast cancer

Background: We have previously reported the prognostic role of humoral antigen spreading response against prostate-related antigen (PRA) for metastatic recurrent breast cancer (mrBC) patients who received personalized peptide vaccine (PPV) therapy (Toh U, SABCS 2015). The prognostic effect was additionally evaluated by the clinical relevant factors including intrinsic subtype, the regimens of combined chemo-hormonal therapies in present study.

Methods:We analyzed serum IgG responses to all of the peptide candidates included PRAs (PSA, PAP and PMSA) after PPV therapy by the Luminex systemusing peripheral blood samples from 77 vaccinated mrBC patients. The clinical factors and relevant events were statistically evaluated.

Results: After 6 and 12cycles of PPV therapy, the serum IgG of anti-PSA, anti-PAP, and/or anti-PMSA increased significantly in 31 patients (PRA response group), and the median progression free survival (PFS) and median overall survival (OS) were 8.1 and 14.3 months, but were 5.1 and 10.8 months, respectively, in the remaining 46 patients with no anti-PRA IgG response (PRA non-response Group). The anti-PRA IgG level was marginally correlated withPFS (p=0.059) and OS (p=0.082) between these two groups, which was a significant prognostic factor for PFS (Log-rank: 0.009) in estrogen-positive cancer patients (ER+). The statistical analyses showed that the clinical outcome was in favor of &gt; 60 year-old patients, those with longer PPV therapies (&gt;3 months), and those who received combined standard hormonal therapies or bisphosphonate/anti-RANKL therapy.

Conclusions: This study indicated a clinical significance between the pre-and post- PPV therapy measurement of serum anti-PRA IgG in patients with mrBC, which may be a useful prognostic marker for monitoring peptide vaccine treatment outcomes, particularly for patients &gt; 60 years with ER+ breast cancer. These results also suggest that the immunotherapeutic peptide vaccine could be efficiently combined with hormonal therapy, anti-HER2 therapy, and bisphosphonate/anti-RANKL therapy in mrBC patients.

Citation Format: Toh U, Saku S, Iwakuma N, Takao Y, Okabe M, Akashi M, Yamada A, Shichijo S, Itoh K, Akagi Y. Prognostic factors for therapeutic personalized peptide vaccines in patients with metastatic recurrent breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-05-09.

Quantification of Turbulent Driving Forces for the Geodesic Acoustic Mode in the JFT-2M Tokamak

We investigate spatial structures of turbulence and turbulent transport modulated by the geodesic acoustic mode (GAM), from which the excitation mechanism of the GAM is discussed. The GAM is found to be predominantly excited through a localized Reynolds stress force, rather than the dynamic shearing force. The evaluated growth rate is larger than the linear damping coefficients and is on the same order of magnitude as the effective growth rate evaluated from time evolution in the GAM kinetic energy.

Performance measures for a dialysis setting

OBJECTIVES

This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views.

METHODS

Two surveys were conducted using self-administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded.

RESULTS

Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient-centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/employee satisfaction, but showed relatively low concerns for patient-centred health care and employee development. However, dialysis managers' usefulness perceptions were significantly higher than staff.

CONCLUSIONS

Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/indicators should be explored for further improvement.

Quantum-disordered state of magnetic and electric dipoles in an organic Mott system

Strongly enhanced quantum fluctuations often lead to a rich variety of quantum-disordered states. Developing approaches to enhance quantum fluctuations may open paths to realize even more fascinating quantum states. Here, we demonstrate that a coupling of localized spins with the zero-point motion of hydrogen atoms, that is, proton fluctuations in a hydrogen-bonded organic Mott insulator provides a different class of quantum spin liquids (QSLs). We find that divergent dielectric behavior associated with the approach to hydrogen-bond order is suppressed by the quantum proton fluctuations, resulting in a quantum paraelectric (QPE) state. Furthermore, our thermal-transport measurements reveal that a QSL state with gapless spin excitations rapidly emerges upon entering the QPE state. These findings indicate that the quantum proton fluctuations give rise to a QSL—a quantum-disordered state of magnetic and electric dipoles—through the coupling between the electron and proton degrees of freedom.

The organic material κ-H₃(Cat-EDT-TTF)₂ has been suggested to exhibit a quantum spin liquid phase in which quantum fluctuations prevent the formation of magnetic order. Here, the authors show that this may be a result of fluctuations of hydrogen atoms, rather than more conventional geometric frustration.

Turbulent transport reduction induced by transition on radial electric field shear and curvature through amplitude and cross-phase in torus plasma

Spatiotemporal evolutions of radial electric field and turbulence are measured simultaneously in the H-mode transition, which is a prototypical example of turbulence structure formation in high-temperature plasmas. In the dynamical phase where transport barrier is established abruptly, the time-space-frequency-resolved turbulent particle flux is obtained. Here we report the validation of the mechanism of transport barrier formation quantitatively. It is found that the particle flux is suppressed predominantly by reducing density fluctuation amplitude and cross phase between density fluctuation and potential fluctuation. Both radial electric field shear and curvature are responsible for the amplitude suppression as was predicted by theory. Turbulence amplitude reduction immediately responds to the growth of the radial electric field non-uniformity and saturates, while cross phase continuously approaches zero.

Crystallization and vitrification of electrons in a glass-forming charge liquid

Charge ordering (CO) is a phenomenon in which electrons in solids crystallize into a periodic pattern of charge-rich and charge-poor sites owing to strong electron correlations. This usually results in long-range order. In geometrically frustrated systems, however, a glassy electronic state without long-range CO has been observed. We found that a charge-ordered organic material with an isosceles triangular lattice shows charge dynamics associated with crystallization and vitrification of electrons, which can be understood in the context of an energy landscape arising from the degeneracy of various CO patterns. The dynamics suggest that the same nucleation and growth processes that characterize conventional glass-forming liquids guide the crystallization of electrons. These similarities may provide insight into our understanding of the liquid-glass transition.

A clustering approach to identify and characterize the asthma and chronic obstructive pulmonary disease overlap phenotype

BACKGROUND

Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases. The phenotypes that have clinical features of both asthma and COPD are still incompletely understood.

OBJECTIVE

To clarify the best discriminators of the asthma-COPD overlap phenotype from asthma and COPD subgroups using a clustering approach.

METHODS

This study assessed pathophysiological parameters, including mRNA expression levels of T helper cell-related transcription factors, namely TBX21 (Th1), GATA3 (Th2), RORC (Th17) and FOXP3 (Treg), in peripheral blood mononuclear cells in asthma patients (n=152) and in COPD patients (n=50). Clusters were determined using k-means clustering. Exacerbations of asthma and COPD were recorded during the 1-year follow-up period.

RESULTS

The cluster analysis revealed four biological clusters: cluster 1, predominantly patients with COPD; cluster 2, patients with an asthma-COPD overlap phenotype; cluster 3, patients with non-atopic and late-onset asthma; and cluster 4, patients with early-onset atopic asthma. Hazard ratios for exacerbation were 2.5 (95% confidence interval [CI], 1.1-5.6) in cluster 1 and 2.3 (95% CI, 1.0-5.0) in cluster 2 compared with patients in other clusters. Cluster 2 was discriminated from other clusters by total serum IgE level ≥310 IU/mL, blood eosinophil counts ≥280 cells/μL, a higher ratio of TBX21/GATA3, FEV₁ /FVC ratio <0.67 and smoking ≥10 pack-years with an area under the curve of 0.94 (95% CI, 0.90-0.98) in the receiver operating characteristic analysis.

CONCLUSIONS AND CLINICAL RELEVANCE

The asthma-COPD overlap phenotype was characterized by peripheral blood eosinophilia and higher levels of IgE despite the Th2-low endotype.

Suggestion of the updated IVIS cut-off values for identifying non-ocular irritants in the bovine corneal opacity and permeability (BCOP) assay

The bovine corneal opacity and permeability (BCOP) assay is an alternative to the Draize test in rabbits. Although it can be used to evaluate ocular non-irritants and severe irritants, it is not used for the assessment of mild-irritating substances. In this assay, a chemical with an in vitro irritancy score (IVIS)≤3 is defined as a "non-irritant" while one with an IVIS>55 is defined as a "corrosive" or "severe irritant." We attempted to evaluate mild eye irritants by assessing the recovery of corneal lesions histopathologically. Our results indicated that chemicals with IVIS≤6 may be defined as "non-irritants," because the rapid recovery of lesions limited to the squamous layer was predicted by the histopathology. In cases where lesions extended to the wing and basal cell layers, when some intact basal cells remained, the lesions were also predicted to be reversible. Thus, chemicals which induce lesions in which basal cells remain intact can be considered to be mild irritants.

Abstract 5106: In vitro and in vivo evaluation of WAC-224, a novel quinolone class of topoisomerase II inhibitor for cancer therapy

Introduction: DNA topoisomerases (Topo) are classical but still attractive targets for drug therapy in multiple types of cancers. Topo inhibitors, such as Etoposide and Daunorubicin, have been effectively used; however, their clinical use is often limited by drug resistance in cancer cell population. Therefore, the development of a novel chemical class of Topo inhibitors has been desired to overcome drug resistance. Recently, Vosaroxin (QINPREZO) is identified as a first-in-class anti-cancer quinolone derivative targeting Topo II, which is under development for relapsed or refractory acute myeloid leukemia (AML). In this study, we evaluated the in vitro and in vivo activities of WAC-224, a novel quinolone derivative for Topo II inhibition, for various cancer cell lines including multi-drug resistant cells and in mouse xenograft models, respectively.

Materials and Methods: In vitro anti-proliferative activities against over 20 cell lines were determined using WST cell proliferation reagent. Apoptosis was measured by Annexin-V staining. In vivo anti-tumor activity was determined in immunodeficient mice bearing multi-drug resistant human uterine sarcoma MES-SA/DX5.

Results: WAC-224 accomplished extensive anti-proliferative activities for cancer cell lines including multi-drug resistant ones with the EC50 range of 0.001 to 1 microM. Especially, in MV4-11 AML cell line, WAC-224 showed a potent and superior anti-proliferative activity compared with Doxorubicin (EC50: 1.4 nM for WAC-224 v.s. 2.5 nM for Doxorubicin). Molecular and cellular mechanisms of WAC-224 were defined as inhibition of human Topo II, induction of G2/M phase cell cycle arrest and apoptosis. Additionally, significant antitumor effects of WAC-224 were confirmed in mouse xenograft models. Furthermore, WAC-224 showed no toxic effect on small intestinal crypts in mice.

Conclusion: This study demonstrated that WAC-224 has strong in vitro activities against broad cancer cell types along with the potent in vivo efficacy and well tolerability, without gastrointestinal toxicity. These results indicate that WAC-224 is promised to provide a new therapeutic option for various cancers including multi-drug resistant and hematological ones.

Citation Format: Taichi Ueshima, Tomonori Yamaguchi, Kenji Itoh, Naoki Kashimoto, Tatsuya Hirano, Rumiko Shimabara, Yohei Kawakubo, Masayuki Sato, Junpei Yamashita, Akira Yazaki, Koichi Tamura. In vitro and in vivo evaluation of WAC-224, a novel quinolone class of topoisomerase II inhibitor for cancer therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5106. doi:10.1158/1538-7445.AM2017-5106

How turbulence fronts induce plasma spin-up

A calculation which describes the spin-up of toroidal plasmas by the radial propagation of turbulence fronts with broken parallel symmetry is presented. The associated flux of parallel momentum is calculated by using a two-scale direct-interaction approximation in the weak turbulence limit. We show that fluctuation momentum spreads faster than mean flow momentum. Specifically, the turbulent flux of wave momentum is stronger than the momentum pinch. The scattering of fluctuation momentum can induce edge-core coupling of toroidal flows, as observed in experiments.

Evaluation of the Effects of S-Allyl-L-cysteine, S-Methyl-L-cysteine, trans-S-1-Propenyl-L-cysteine, and Their N-Acetylated and S-Oxidized Metabolites on Human CYP Activities

Three major organosulfur compounds of aged garlic extract, S-allyl-L-cysteine (SAC), S-methyl-L-cysteine (SMC), and trans-S-1-propenyl-L-cysteine (S1PC), were examined for their effects on the activities of five major isoforms of human CYP enzymes: CYP1A2, 2C9, 2C19, 2D6, and 3A4. The metabolite formation from probe substrates for the CYP isoforms was examined in human liver microsomes in the presence of organosulfur compounds at 0.01-1 mM by using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Allicin, a major component of garlic, inhibited CYP1A2 and CYP3A4 activity by 21-45% at 0.03 mM. In contrast, a CYP2C9-catalyzed reaction was enhanced by up to 1.9 times in the presence of allicin at 0.003-0.3 mM. SAC, SMC, and S1PC had no effect on the activities of the five isoforms, except that S1PC inhibited CYP3A4-catalyzed midazolam 1'-hydroxylation by 31% at 1 mM. The N-acetylated metabolites of the three compounds inhibited the activities of several isoforms to a varying degree at 1 mM. N-Acetyl-S-allyl-L-cysteine and N-acetyl-S-methyl-L-cysteine inhibited the reactions catalyzed by CYP2D6 and CYP1A2, by 19 and 26%, respectively, whereas trans-N-acetyl-S-1-propenyl-L-cysteine showed weak to moderate inhibition (19-49%) of CYP1A2, 2C19, 2D6, and 3A4 activities. On the other hand, both the N-acetylated and S-oxidized metabolites of SAC, SMC, and S1PC had little effect on the reactions catalyzed by the five isoforms. These results indicated that SAC, SMC, and S1PC have little potential to cause drug-drug interaction due to CYP inhibition or activation in vivo, as judged by their minimal effects (IC₅₀>1 mM) on the activities of five major isoforms of human CYP in vitro.

Eye-Movement Analysis of Track Monitoring Patterns of Night Train Operators: Effects of Geographic Knowledge and Fatigue

Track maintenance is one of the most critical activities for railway safety, particularly for high-speed trains. In maintaining tracks, a number of special purpose trains are used for materials transportation, inspection of the track and rails, construction and other purposes. These track maintenance trains are operated under stressful and changing conditions such as the lack of traffic signals and low visibility. Therefore, it is of great importance to investigate train operators' human factors for enhancement of their operation quality and reliability. The present paper particularly focuses on their geographic knowledge on driving area and fatigue by time course as such factors. Through task analysis using eye-tracking data recorded during performance of track inspection task, several analytical diagrams were produced: transition network of attention allocation, distribution of eye-gaze duration at each location on the ground and surroundings, and so forth. Based on these results, we examine the effects of the train operator's human factors on their cognitive and perceptual processes, and also discuss the operator's strategy for obstacle detection on the track.

Analysis of Cognitive Attitudes to Commercial Films on Basis of Eye Tracking Data

The present paper proposes a method for analyzing viewers' cognitive attitudes to commercial films (CF) on TV based on the eye-movement recording (EMR) technique and scenario description of a CF. In this method, a scenario is described in a time-line transition of displaying CF ingredients in a scene. CF ingredients are classified into three groups in terms of involvement of advertised claims: direct claimed items, indirect claimed items and no-claim involved items. This classification allows us not only to provide with a framework for analyzing EMR data but also to estimate claimed quantity containing a CF. A viewer's EMR data during watching a CF is transcribed according to this scenario description scheme. His/her cognitive attitudes to a particular CF are analyzed mainly based on two attitudinal measurements that can be generated by the EMR transcription combined with the scenario description. One measurement, effective gaze ratio, is relating to how intensively a viewer watches a CF. The other measurement, claim perception ratio, is an index for estimating how well a viewer acquires claims or messages regarding an advertised product, service or organization from the commercial film.

A series of experiments were carried out with four subjects to obtain their eye-movement data using an ASL 4000 tracking system. Each subject performed six CF-watching sessions each of which was conducted on a different day using the same sixteen commercial films. The proposed method was applied to the experimental data to analyze the viewer's cognitive patterns to CF's. The obtained cognitive attitudes are discussed from relations between their individual attributes such as watching style of CF's and daily TV watching hours. Based on these results, we mentioned some implications on design parameters of CF's such as frequency of changing scene, and effects of celebrity.

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial

Objectives:

To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.

Design:

Parallel-arm, individual randomized controlled trial.

Methods:

Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups.

Results:

Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001).

Conclusion:

The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly.

ClinicalTrial.govIdentifier-UMIN000015567