Self-Sustained Divertor Oscillation Driven by Magnetic Island Dynamics in Torus Plasma

A new type of self-sustained divertor oscillation is discovered in the Large Helical Device stellarator, where the peripheral plasma is detached from material diverters by means of externally applied perturbation fields. The divertor oscillation is found to be a self-regulation of an isolated magnetic field structure (the magnetic island) width induced by a drastic change in a poloidal inhomogeneity of the plasma radiation across the detachment-attachment transitions. A predator-prey model between the magnetic island width and a self-generated local plasma current (the bootstrap current) is introduced to describe the divertor oscillation, which successfully reproduces the experimental observations.

Severe pancreatic injury with total disruption of main pancreatic duct successfully managed by multi‐stage endoscopic therapy: a case report

Background

The management of pancreatic injury is not well‐established. Recently, endoscopic therapy has been reported as a treatment option for main pancreatic duct disruption.

Case Presentation

A 68‐year‐old man presented to our hospital and was diagnosed with severe traumatic pancreatic injury that developed 2 days prior. Endoscopic retrograde cholangiopancreatography revealed main pancreatic duct disruption. Although initial stenting to the distal main pancreatic duct was not achieved because of the widespread intermediate fluid collection, an endoscopic naso‐pancreatic drainage tube was successfully inserted into via the main duodenal papilla. After drainage, the endoscopic naso‐pancreatic drainage tube was replaced with an endoscopic retrograde pancreatic drainage tube, and a stent was successfully placed into the distal main pancreatic duct via the minor papilla.

Conclusion

We report a case of severe pancreatic injury managed using multi‐stage endoscopic therapy that could be a possible treatment strategy for pancreatic injury with total main pancreatic duct disruption.

Characterization of the In Vitro and In Vivo Efficacy of Baloxavir Marboxil against H5 Highly Pathogenic Avian Influenza Virus Infection

Human infections caused by the H5 highly pathogenic avian influenza virus (HPAIV) sporadically threaten public health. The susceptibility of HPAIVs to baloxavir acid (BXA), a new class of inhibitors for the influenza virus cap-dependent endonuclease, has been confirmed in vitro, but it has not yet been fully characterized. Here, the efficacy of BXA against HPAIVs, including recent H5N8 variants, was assessed in vitro. The antiviral efficacy of baloxavir marboxil (BXM) in H5N1 virus-infected mice was also investigated. BXA exhibited similar in vitro activities against H5N1, H5N6, and H5N8 variants tested in comparison with seasonal and other zoonotic strains. Compared with oseltamivir phosphate (OSP), BXM monotherapy in mice infected with the H5N1 HPAIV clinical isolate, the A/Hong Kong/483/1997 strain, also caused a significant reduction in viral titers in the lungs, brains, and kidneys, thereby preventing acute lung inflammation and reducing mortality. Furthermore, compared with BXM or OSP monotherapy, combination treatments with BXM and OSP using a 48-h delayed treatment model showed a more potent effect on viral replication in the organs, accompanied by improved survival. In conclusion, BXM has a potent antiviral efficacy against H5 HPAIV infections.

[A curatively resectable case of cholangiocarcinoma 52 years after cholecystoduodenostomy for biliary atresia]

A 52-year-old female had cholecystoduodenostomy for biliary atresia of type I cyst at 120 days of age. The patient's surgery recovery was uneventful;however, the patient had recurring cholangitis at the age of 27. The patient had high hepatobiliary enzymes in the outpatient clinic and was diagnosed with cholangitis. In general, the Kasai method is the mainstream for biliary atresia, since it has a much-reduced incidence of both early and late postoperative problems. However, this patient had biliary atresia of type I cyst and had undergone cholecystoduodenostomy. We suspected that the obstructive cholangitis was caused by the relatively wide anastomosis opening into the duodenal bulb, where the stomach contents pass through the most, and the poor clearance owing to the convoluted cystic duct;therefore, we chose to place a stent endoscopically. However, to our surprise, Class V was detected in the bile cytology performed as a precaution. Although no tumor was seen on imaging such as contrast-enhanced CT, EUS, and PET/CT, mapping biopsy results showed the presence of cancer at the bifurcation of the cystic duct. The patient had cholangiocarcinoma confined to the extrahepatic bile ducts only;thus, extrahepatic bile duct resection was conducted. The patient was discovered to have biliary intraepithelial neoplasia-3, and the tumor was entirely respectable. The patient had a good postoperative course, with normalization of liver function and no recurrence of cholangitis. In this case, cholangiocarcinoma was detected at an early stage by cytological examination performed as a precaution during endoscopic therapy for recurrent cholangitis. In addition to the fact that the long-term pathogenesis of biliary atresia is still unknown, it is important to note the presence of malignancy, which has the greatest effect on the patient prognosis, considering that the course of the disease varies depending on the operation carried out. Because cholecystoduodenostomy for biliary atresia is a rare approach, and there has been no previous report of related cholangiocarcinoma, we report this case for the benefit of gastroenterologists who may encounter similar cases in the future.

Association of device-measured physical activity with peak oxygen consumption measured by cardiopulmonary exercise testing in patients with cardiac implantable electronic devices

PURPOSE

Cardiac implantable electronic devices (CIEDs) offer diagnostic information such as device-measured physical activity (PA). Peak oxygen consumption (VO₂) measured by cardiopulmonary exercise testing (CPET) is the most objective variable showing exercise capacity. The purpose of this study was to investigate the relationship between these 2 variables.

METHODS

We retrospectively studied consecutive patients with CIEDs undergoing CPET between April 1, 2018, and January 31, 2021. These patients were divided into 2 groups: patients with peak VO₂ ≤ 14 ml/kg/min (low peak VO₂ group) and those showing peak VO₂ > 14 ml/kg/min (high peak VO₂ group). The peak device-measured PA was compared between the 2 groups. The relationship between the peak device-measured PA and peak VO₂ was also investigated.

RESULTS

There were 50 and 51 patients in the low and high peak VO₂ groups, respectively. The peak device-measured PA, which was expressed in units of hours/day, was significantly lower in the low peak VO₂ group than in the high peak VO₂ group (3.06, interquartile range [2.43-4.00] vs. 5.50, interquartile range [4.04-6.70] p < 0.01). The peak device-measured PA and peak VO₂ showed a significant positive correlation (Spearman's ρ = 0.53; p < 0.01). Furthermore, receiver operating characteristic curve analysis showed that a peak device-measured PA > 3.87 h/day could predict high peak VO₂ (80.4%, sensitivity; 72.0%, specificity). In multivariate linear regression analysis, peak device-measured PA was an independent predictor of peak VO₂ (regression coefficient, 0.61; 95% confidence interval, 0.33-0.89; p < 0.01).

CONCLUSIONS

Peak device-measured PA was significantly associated with peak VO₂.

Trends in current alcohol use among Japanese adolescents by sociodemographic groups

Background

Alcohol is the most commonly used substance among Japanese adolescents, although its use has been declining recently. However, little is known whether the declining trend in adolescent drinking can be found across all sociodemographic characteristics. This study explored time trends in alcohol use among Japanese adolescents by sociodemographic characteristics between 2008 and 2016.

Methods

A repeated cross-sectional study was conducted using data from three prefectural-wide surveys of public high schools in Okinawa Prefecture, Japan, in 2008, 2012, and 2016. The study participants comprised 7,807 students in grades 10 to 12 (15-18 years). Alcohol use was defined as drinking one or more alcoholic beverages on at least one day in the past month. Demographic characteristics included grade, sex, and region, and socioeconomic status (SES) was assessed by family structure, parental education, and school type. Time trends in alcohol use over time by each sociodemographic group were assessed by the Cochran-Armitage test for trend.

Results

The overall prevalence of adolescent alcohol use significantly reduced from 20.7% (95% CI 19.1-22.3%) in 2008 to 9.5% (95%CI 8.4-10.6%) in 2016. Similar reducing trends in adolescent alcohol use were found across all of the demographic characteristics as well as the SES groups (all P for trends &lt;0.001). During the survey periods, there were no sex differences in alcohol use prevalence, while alcohol use was more prevalent among old graders. Alcohol use was also more prevalent among low SES groups than high SES groups. However, family structure in 2016 did not show significant differences in alcohol use.

Conclusions

Alcohol use among Japanese adolescents has been declining over time and this downward trend was similar for all demographic and socioeconomic subgroups. Further adolescent drinking prevention efforts should be implemented across all population subgroups. Moreover. monitoring of adolescent alcohol use should be continued.

Key messages

This study found that adolescent alcohol use in Japan has been decreasing over time across all population subgroups. The finding is a desired outcome from the viewpoint of the public health impact.

Adherence to 24-hour movement guidelines among Japanese elementary and junior high school students

Background

For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5-17 years) recommend an achievement of ≥ 60 minutes of moderate-to-vigorous physical activity (MVPA), &lt;2 h of recreational screen time (ST), and 9-11 h for 5-13 years or 8-10 h for 14-17 years of sleep time (SLT) each day. There is little evidence showing the proportion of the recommendation in Japan, so we need to investigate. The aim of this study thus was to reveal the compliance to the recommendation with a large sample of Japanese elementary and junior high school children.

Methods

This study included 2408 students enrolled in fifth grade (aged 10-11 years) in 31 elementary schools, and 4360 students enrolled in eighth grade (aged 13-14 years) in 30 junior high schools. Each behaviour was assessed by a self-reported questionnaire. To analyze the differences in adherence to the recommendation between the school-aged group, we conducted a chi-analysis.

Results

Overall, only 4% of participants complied with all three recommendations, and 20% of the students did not comply with any of the recommendations (χ2=1390.87;p&lt;.001). Compared with MVPA and ST, SLT had a trend to be likely to achieve the recommendation in each school-age group. Elementary school students had a higher percentage of non-adherence to all recommendations (39%) than junior high school students (10.3%). The adherence to the recommendation of the ST & SLT simultaneously had no differences in each age group (11.5% for elementary schoolers and 12.7% for junior high schoolers). However, adherence to the recommendation of MVPA only, ST only, and MVPA & ST were higher in elementary schoolers, and the adherence to the recommendation of SLT only and MVPA & SLT were higher in junior high schoolers.

Conclusions

The proportion of adherence to at least one of the three recommendations is better in junior high school students than elementary school students in Okinawa, Japan.

Key messages

Health behaviour required improvement may differ by age group. It is necessary for particularly elementary school children in Okinawa to take proper countermeasures to improve the movement behaviours.

A rare case of hepatocellular carcinoma with bile duct invasion diagnosed by peroral cholangioscopy

Video 1Peroral cholangioscopy showed a 20-mm-diameter, stalked, floating, round mass in the hilar region. The surface of the tumor was covered with white fur, and the tumor tissue was partially exposed in a map-like pattern. The mass was penetrable even with a guidewire, and it bled easily. Biopsies were performed using biopsy forceps, and the tumor bled easily even with biopsy.

Technical Note: Range verification of pulsed proton beams from fixed-field alternating gradient accelerator by means of time-of-flight measurement of ionoacoustic waves

PURPOSE

Ionoacoustics is one of the promising approaches to verify the beam range in proton therapy. However, the weakness of the wave signal remains a main hindrance to its application in clinics. Here we studied the potential use of a fixed-field alternating gradient accelerator (FFA), one of the accelerator candidates for future proton therapy. For such end, magnitude of the pressure wave and range accuracy achieved by the short-pulsed beam of FFA were assessed, using both simulation and experimental procedure.

METHODS

A 100 MeV proton beam from the FFA was applied on a water phantom, through the acrylic wall. The beam range measured by the Bragg peak (BP)-ionization chamber (BPC) was 77.6 mm, while the maximum dose at BP was estimated to be 0.35 Gy/pulse. A hydrophone was placed 20 mm downstream of the BP, and signals were amplified and stored by a digital oscilloscope, averaged, and low-pass filtered. Time-of-flight (TOF) and two relative TOF values were analyzed in order to determine the beam range. Furthermore, an acoustic wave transport simulation was conducted to estimate the amplitude of the pressure waves.

RESULTS

The range calculated when using two relative TOF was 78.16 ± 0.01 and 78.14 ± 0.01 mm, respectively, both values being coherent with the range measured by the BPC (the difference was 0.5-0.6 mm). In contrast, utilizing the direct TOF resulted in a range error of 1.8 mm. Fivefold and 50-fold averaging were required to suppress the range variation to below 1 mm for TOF and relative TOF measures, respectively. The simulation suggested the magnitude of pressure wave at the detector exceeded 7 Pascal.

CONCLUSION

A submillimeter range accuracy was attained with a pulsed beam of about 21 ns from an FFA, at a clinical energy using relative TOF. To precisely quantify the range with a single TOF measurement, subsequent improvement in the measuring system is required.

Effect of supplementation with the reduced form of coenzyme Q10 on semen quality and antioxidant status in dogs with poor semen quality: Three case studies

Oxidative stress owing to an imbalance between reactive oxygen species and antioxidants, such as coenzyme Q10 (CoQ10), is a major contributor to male infertility. We investigated the effects of the reduced form of CoQ10 (ubiquinol) supplementation on semen quality in dogs with poor semen quality. Three dogs received 100 mg of ubiquinol orally once daily for 12 weeks. Semen quality, serum testosterone, and seminal plasma superoxide dismutase (SOD) activity were examined at 2-week intervals from 2 weeks before ubiquinol supplementation to 4 weeks after the treatment. Ubiquinol improved sperm motility, reduced morphologically abnormal sperm, and increased seminal plasma SOD activity; however, it had no effect on testosterone level, semen volume, and sperm number. Ubiquinol supplementation could be used as a non-endocrine therapy for infertile dogs.

Diagnostic Accuracy of Screening Arterial Spin-Labeling MRI Using Hadamard Encoding for the Detection of Reduced CBF in Adult Patients with Ischemic Moyamoya Disease

BACKGROUND AND PURPOSE

Adult patients with ischemic Moyamoya disease are advised to undergo selective revascularization surgery based on cerebral hemodynamics. The purpose of this study was to determine the diagnostic accuracy of arterial spin-labeling MR imaging using Hadamard-encoded multiple postlabeling delays for the detection of reduced CBF in such patients.

MATERIALS AND METHODS

Thirty-seven patients underwent brain perfusion SPECT and pseudocontinuous arterial spin-labeling MR imaging using standard postlabeling delay (1525 ms) and Hadamard-encoded multiple postlabeling delays. For Hadamard-encoded multiple postlabeling delays, based on data obtained from the 7 sub-boluses with combinations of different labeling durations and postlabeling delays, CBF corrected by the arterial transit time was calculated on a voxel-by-voxel basis. Using a 3D stereotaxic template, we automatically placed ROIs in the ipsilateral cerebellar hemisphere and 5 MCA territories in the symptomatic cerebral hemisphere; then, the ratio of the MCA to cerebellar ROI was calculated.

RESULTS

The area under the receiver operating characteristic curve for detecting reduced SPECT-CBF ratios (<0.686) was significantly greater for the Hadamard-encoded multiple postlabeling delays-CBF ratios (0.885) than for the standard postlabeling delay-CBF ratios (0.786) (P = .001). The sensitivity and negative predictive value for the Hadamard-encoded multiple postlabeling delays-CBF ratios were 100% (95% confidence interval, 100%-100%) and significantly higher than the sensitivity (95% CI, 44%-80%) and negative predictive value (95% CI, 88%-97%) for the standard postlabeling delay-CBF ratio, respectively.

CONCLUSIONS

ASL MR imaging using Hadamard-encoded multiple postlabeling delays may be applicable as a screening tool because it can detect reduced CBF on brain perfusion SPECT with 100% sensitivity and a 100% negative predictive value in adult patients with ischemic Moyamoya disease.

Patient's age and D-dimer levels predict the prognosis in patients with TAFRO syndrome

Objectives

To identify prognostic factors for TAFRO syndrome, a rare inflammatory disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly.

Methods

Data of patients with TAFRO syndrome were extracted from a Japanese patient registry. Patients were divided into groups according to the clinical and laboratory parameters at initial presentation. Cut-off values for the laboratory parameters were determined using receiver operating characteristic curve analysis and by clinical relevance. Patient survival was analyzed by the Kaplan–Meier method. Univariable analysis was performed using log-rank tests. Multivariable analyses were performed with the logistic regression model and the Cox proportional hazards model.

Results

We extracted the data of 83 patients with TAFRO syndrome from the registry. Univariable analysis identified several potential prognostic factors. Of these factors, age ≥60 years and D-dimer ≥18 μg/dL remained significant predictors of poor overall survival in the multivariable Cox proportional hazards model. Based on these results, we developed a simple prognostic scoring system for TAFRO syndrome (TS-PSS).

Conclusion

Patients in our cohort were stratified into low, intermediate, and high-risk groups by the TS-PSS. This system should be verified with independent patient cohorts in future studies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12185-021-03159-x.

222 Rn emanation measurements for the XENON1T experiment

The selection of low-radioactive construction materials is of utmost importance for the success of low-energy rare event search experiments. Besides radioactive contaminants in the bulk, the emanation of radioactive radon atoms from material surfaces attains increasing relevance in the effort to further reduce the background of such experiments. In this work, we present the 222 Rn emanation measurements performed for the XENON1T dark matter experiment. Together with the bulk impurity screening campaign, the results enabled us to select the radio-purest construction materials, targeting a 222 Rn activity concentration of 10 μ Bq / kg in 3.2 t of xenon. The knowledge of the distribution of the 222 Rn sources allowed us to selectively eliminate problematic components in the course of the experiment. The predictions from the emanation measurements were compared to data of the 222 Rn activity concentration in XENON1T. The final 222 Rn activity concentration of ( 4.5 ± 0.1 ) μ Bq / kg in the target of XENON1T is the lowest ever achieved in a xenon dark matter experiment.

Prognostic ability of mid-term worsening renal function after percutaneous coronary intervention: findings from the SHINANO registry

Chronic kidney disease is a prognostic factor for cardiovascular disease. Worsening renal function (WRF), specifically, is an important predictor of mortality in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). We evaluate the prognostic impact of mid-term WRF after PCI on future cardiovascular events. We examined the renal function data of 1086 patients in the first year after PCI using the SHINANO 5-year registry. Patients were divided into two groups, mid-term WRF and non-mid-term WRF, and primary outcomes were major adverse cardiovascular events (MACE) and death. Mid-term WRF was defined as an increase in creatinine (≥ 0.3 mg/dL) in the first year after PCI. Mid-term WRF was found in 101 patients (9.3%), and compared to non-mid-term WRF, it significantly increased the incidence of MACE (p < 0.001), and all-cause death (p < 0.001), myocardial infarction (p = 0.001). Furthermore, mid-term WRF patients had higher incidence of future heart failure (p < 0.001) and new-onset atrial fibrillation (p = 0.01). Patients with both mid-term WRF and chronic kidney disease had increased MACE compared to patients with either condition alone (p < 0.001). Similarly, patients with mid-term WRF and acute kidney injury had increased MACE compared to patients with either condition alone (p < 0.001). Multivariate Cox regression analysis revealed mid-term WRF as a strong predictor of MACE (hazard ratio: 2.50, 95% confidence interval 1.57–3.98, p < 0.001). Mid-term WRF after PCI negatively affects MACE, as well as future admission due to heart failure and new-onset atrial fibrillation, chronic kidney disease, and acute kidney injury.

Clinical utility of CorVue intrathoracic impedance alert with device-measured physical activity in predicting heart failure events

Cardiac implantable electronic devices (CIEDs) offer heart failure (HF) diagnostic information, including intrathoracic impedance (ITI) or physical activity (PA). However, few studies have evaluated the utility of these parameters measured by CIEDs with CorVue algorithm. The purpose of this study was to investigate the relationship between ITI alerts triggered by the CorVue algorithm and HF development. We also examined the association between device-measured PA and ITI alerts associated with HF development. We retrospectively studied consecutive patients with CIEDs equipped with CorVue algorithm, which were implanted between June 1, 2011 and August 31, 2019. These patients were divided into two groups: patients with decreased ITI followed by the ITI alerts (ITI alert group) and those without the alerts (non-ITI alert group). There were 35 and 14 patients in the ITI and non-ITI alert groups, respectively. A total of 96 ITI alerts were observed. ITI alerts associated with HF development were observed in 21% (20/96); whereas, ITI alerts not associated with HF development were observed in 79% (76/96). Accurate device-measured PA was confirmed in 76 ITI alerts, which consisted of 30 alerts with lower PA and 46 alerts without lower PA. ITI alerts associated with HF development were observed in 30% (9/30) of the alerts with lower PA, whereas observed only in 6.5% (3/46) of the alerts without lower PA. In conclusion, the CorVue ITI alerts indicated a high false-positive rate. However, device-measured PA may be useful to determine whether ITI alerts are associated with HF development or not, which was attributed to the high negative predictive value.

Search for Coherent Elastic Scattering of Solar ^{8}B Neutrinos in the XENON1T Dark Matter Experiment

We report on a search for nuclear recoil signals from solar ^{8}B neutrinos elastically scattering off xenon nuclei in XENON1T data, lowering the energy threshold from 2.6 to 1.6  keV. We develop a variety of novel techniques to limit the resulting increase in backgrounds near the threshold. No significant ^{8}B neutrinolike excess is found in an exposure of 0.6  t×y. For the first time, we use the nondetection of solar neutrinos to constrain the light yield from 1-2 keV nuclear recoils in liquid xenon, as well as nonstandard neutrino-quark interactions. Finally, we improve upon world-leading constraints on dark matter-nucleus interactions for dark matter masses between 3 and 11  GeV c^{-2} by as much as an order of magnitude.

Quasifree Neutron Knockout Reaction Reveals a Small s-Orbital Component in the Borromean Nucleus ^{17}B

A kinematically complete quasifree (p,pn) experiment in inverse kinematics was performed to study the structure of the Borromean nucleus ^{17}B, which had long been considered to have a neutron halo. By analyzing the momentum distributions and exclusive cross sections, we obtained the spectroscopic factors for 1s_{1/2} and 0d_{5/2} orbitals, and a surprisingly small percentage of 9(2)% was determined for 1s_{1/2}. Our finding of such a small 1s_{1/2} component and the halo features reported in prior experiments can be explained by the deformed relativistic Hartree-Bogoliubov theory in continuum, revealing a definite but not dominant neutron halo in ^{17}B. The present work gives the smallest s- or p-orbital component among known nuclei exhibiting halo features and implies that the dominant occupation of s or p orbitals is not a prerequisite for the occurrence of a neutron halo.

Possible involvement of regulatory T cell abnormalities and variational usage of TCR repertoire in children with autoimmune neutropenia

Autoimmune neutropenia (AIN) in childhood is characterized by chronic neutropenia and positivity for anti-neutrophil antibodies, resulting in the excessive destruction of neutrophils. In this study, we investigated the involvement of regulatory T cells (T_regs ) in the pathogenesis of AIN in childhood. T_regs have been classified into three subpopulations based on the expressions of CD45RA and forkhead box protein 3 (FoxP3): resting T_regs , activated T_regs and non-suppressive T_regs . The frequency of activated T_regs (CD4⁺ CD25⁺ FoxP3^high CD45RA^- T cells) as well as that of total T_regs (CD4⁺ CD25⁺ FoxP3⁺ T cells) in peripheral blood was significantly decreased in patients with AIN. Analysis of the T cell receptor (TCR)-Vβ repertoire of CD4⁺ T cells revealed skewed usages in patients with AIN compared with that observed in age-matched control subjects. Regarding T cell subsets, the use of four of 24 TCR-Vβ families in T_regs and one in conventional T cells were increased in patients with AIN. The number of patients with AIN who showed skewed usages of TCR-Vβ family in conventional and T_regs was significantly higher than that reported in control subjects. When the preference between T_regs and conventional T cells in each TCR-Vβ family was individually compared, different use was prominently observed in the TCR-Vβ 9 family in patients with AIN. These results suggest that the quantitative abnormalities of T_regs and the skew of the TCR-Vβ repertoire in CD4⁺ T cells, including T_regs and conventional T cells, may be related to autoantibody production through a human neutrophil antigen-reactive T cell clone.

Surface Localization of the Dineutron in ^{11}Li

The formation of a dineutron in the ^{11}Li nucleus is found to be localized to the surface region. The experiment measured the intrinsic momentum of the struck neutron in ^{11}Li via the (p,pn) knockout reaction at 246  MeV/nucleon. The correlation angle between the two neutrons is, for the first time, measured as a function of the intrinsic neutron momentum. A comparison with reaction calculations reveals the localization of the dineutron at r∼3.6  fm. The results also support the density dependence of dineutron formation as deduced from Hartree-Fock-Bogoliubov calculations for nuclear matter.

Dementia with Lewy Bodies with Pure Agraphia for Kanji (Japanese Morphograms)

A 70-year-old dextral woman was admitted to a hospital with agraphia for kanji (Japanese morphograms). She had a history of severe constipation, nightmares, and visual hallucinations. Neurological examinations revealed no obvious Parkinson's disease symptoms. She showed poor skills in writing the kanji for looking at picture objects, [e.g., writing the Japanese word "inu" (which means dog) when she saw a drawing of a dog] or dictated words. A reduced striatal uptake of [¹²³I]-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) on single-photon-emission computed tomography and reduced meta-iodobenzylguanidine (MIBG) cardiac uptake on myocardial scintigraphy were detected. The accumulation of amyloid beta in the bilateral cerebral cortices was observed on amyloid-positron emission tomography. We herein report a case of Lewy body dementia with pure agraphia for kanji with underlying Alzheimer's disease pathology.

On-line range verification for proton beam therapy using spherical ionoacoustic waves with resonant frequency

In contrast to conventional X-ray therapy, proton beam therapy (PBT) can confine radiation doses to tumours because of the presence of the Bragg peak. However, the precision of the treatment is currently limited by the uncertainty in the beam range. Recently, a unique range verification methodology has been proposed based on simulation studies that exploit spherical ionoacoustic waves with resonant frequency (SPIREs). SPIREs are emitted from spherical gold markers in tumours initially introduced for accurate patient positioning when the proton beam is injected. These waves have a remarkable property: their amplitude is linearly correlated with the residual beam range at the marker position. Here, we present proof-of-principle experiments using short-pulsed proton beams at the clinical dose to demonstrate the feasibility of using SPIREs for beam-range verification with submillimetre accuracy. These results should substantially contribute to reducing the range uncertainty in future PBT applications.

Colorectal and gastric metastases from lobular breast cancer that resembled superficial neoplastic lesions

Breast cancer is the most common malignancy in women and has a risk of late recurrence. We report a case of metastasis to the stomach and colon 23 years after surgery, with characteristic findings. A 74-year-old woman underwent breast cancer resection at the age of 51. At the time, no additional therapy was performed despite the histological diagnosis of invasive lobular carcinoma with lymph node metastasis. Upper gastrointestinal endoscopy, which was performed as a follow-up for her chronic gastritis, revealed multiple erosions. Histology revealed diffuse proliferation of signet ring cell-like atypical cells, that were positive for cytokeratin CAM5.2 and estrogen receptor. These findings suggested metastasis from the invasive lobular breast carcinoma. Positron-emission tomography revealed sternal and vertebral metastases. Colonoscopy also performed to screen for intestinal metastasis revealed several lesions that resembled hyperplastic polyps. Although these lesions were not strongly suspected of metastasis, histology surprisingly revealed the same findings as the gastric metastasis. This case involved gastric and colorectal superficial metastases that were synchronously detected 23 years after primary treatment. We report that early-stage colorectal metastasis may resemble hyperplastic polyps, and biopsy should always be considered in patients with a history of breast cancer, regardless of years elapsed since treatment.

In Vivo Ca2+ Imaging of the Insular Cortex during Experimental Tooth Movement

Pain and discomfort are common problems for patients undergoing orthodontic treatment. We have demonstrated that cortical excitation propagation in the somatosensory and insular cortices (IC) induced by electrical stimulation of the periodontal ligament (PDL) is facilitated 1 d after experimental tooth movement (ETM). However, it is necessary to examine ETM-induced changes in neural responses at a single-cell level to understand the mechanisms of cortical plastic changes, in which excitatory glutamatergic and inhibitory GABAergic neurons are intermingled to form cortical local circuits. We performed in vivo 2-photon Ca²⁺ imaging by loading the Ca²⁺ indicator Oregon Green BAPTA with the astrocyte marker sulforhodamine. We focused on the IC region that exhibited the largest neural response to maxillary PDL (mxPDL) stimulation using a VGAT-Venus transgenic rat that expresses venus fluorescent protein in GABAergic neurons and discerned changes in the neural activities of each cortical neuronal subtype before and during ETM treatment of the maxillary incisor and first molar. Notably, 1 d after ETM treatment (1d-ETM), the number of neurons responding to mxPDL stimulation increased from 47.6% to 64.2% in excitatory neurons and from 44.5% to 66.2% in inhibitory neurons. On the other hand, only 3% to 4% of excitatory and inhibitory neurons responded to mandibular molar PDL (mbPDL) stimulation in control rats, and the 1d-ETM group showed significant increases in excitatory (14.0%) and inhibitory neurons (22.5%) responding to mbPDL stimulation. Interestingly, most mbPDL-responding neurons also responded to mxPDL stimulation. The population of excitatory and inhibitory neurons that responded only to mxPDL stimulation was comparable between the control and 1d-ETM groups. The facilitative responses in the 1d-ETM group had almost recovered 7 d after ETM treatment. These results suggest that ETM induces parallel increases in PDL-responding neurons and changes some insensitive neurons to respond to both mxPDL and mbPDL stimulation.

Mapping of a New Deformation Region around ^{62}Ti

We performed the first direct mass measurements of neutron-rich scandium, titanium, and vanadium isotopes around the neutron number 40 at the RIKEN RI Beam Factory using the time-of-flight magnetic-rigidity technique. The atomic mass excesses of ^{58-60}Sc, ^{60-62}Ti, and ^{62-64}V were measured for the first time. The experimental results show that the two-neutron separation energies in the vicinity of ^{62}Ti increase compared to neighboring nuclei. This shows that the masses of Ti isotopes near N=40 are affected by the Jahn-Teller effect. Therefore, a development of Jahn-Teller stabilization appears below the Cr isotopes, and the systematics in Sc, Ti, and V isotopes suggest that ^{62}Ti is located close to the peak of the Jahn-Teller effect.

Study of factors related to social and emotional skills in early childhood in Japan

Background

There are numerous reports that social and emotional skills in early childhood have profound influence on lifelong health. The aim of this research is to determine the relation between the lifestyle and the social and emotional skills among children in present day Japan.

Methods

The object of analysis was a total of 110 parents of kindergarten students (56 boys, 48 girls,6 gender unknown) from 3 kindergartens in central Okinawa Island. The survey was conducted in mid-December 2019. Regarding the content of the survey, parents were asked to answer on a five-point scale, based on their subjective opinion, how good is their child, as compared to other children, in each of the 9 sub-scales of the social and emotional skills proposed in the 2015 OECD report, namely “perseverance,” “self-control,” “passion for goals,” “sociability,” “respect,” “caring,” “self-esteem,” “optimism,” “confidence.” Additionally, other question items were set, mainly to ask about the child's own lifestyle.

Results

The results of multivariate logistic regression analysis are following. As for “achieving goals:” 3 items for perseverance - “there are few likes and dislikes about food (OR:2.67, 95％CI:1.03～6.94, p=.043),” “Time for playing games on smartphone is determined (OR:3.21, 95％CI:1.19～8.68, p=.021),” “Eat more fruits (OR:3.03, 95％CI:1.24～8.26, p=.016),” are statistically significant. [Other results are omitted in this abstract]

Conclusions

It became clear that the acquisition of social and emotional skills during early childhood generally involves regular lifestyle and “discipline” at home as a whole. Besides, it is important for parent and child to do various activities together, including those aiming to increase cognitive skills. This study is considered to be a powerful evidence for the development of future intervention programme, aimed at acquiring social and emotional skills in early childhood.

Key messages

In early childhood family and kindergarten have to cooperate to foster social and emotional skills, important for lifelong health. This study is considered to be a powerful evidence for the development of future intervention programme, aimed at acquiring social and emotional skills in early childhood.

AB0196 THE ASSOCIATION BETWEEN OSTEOPOROSIS AND FUNCTIONAL IMPAIRMENT EVALUATED BY THE LOCOMO25 IN RHEUMATOID ARTHRITIS

Background:

Locomotive syndrome is a condition in which activities of daily living are affected by impairment of the motor organs, most often due to rheumatoid arthritis (RA). Locomo25 is a new index developed for the early detection of locomotive syndrome. It consists of 25 items associated with pain, physical activity, and subjective state of health, with a score of 7 points or higher classed as Grade 1 locomotive syndrome and a score of 16 points or higher as Grade 2. In RA, joint impairment causes the appearance of problems affecting motor organs as a whole, as well as progressive functional impairment. As functional impairment progresses, it causes increasing immobility, which raises the risk of osteoporosis.

Objectives:

Locomo25 was used to investigate functional impairment and its association with RA disease activity and osteoporosis indicators.

Methods:

The subjects were 105 patients with RA (24 men and 81 women) with a mean age of 68.7 (28–91) years. In terms of staging, 25 were Stage I, 22 Stage II, 17 Stage III, and 41 Stage IV, and their motor disability was Steinbrocker Class 1 in 68 cases, Class 2 in 27, Class 3 in 9, and Class 4 in 1. Disease activity according to the Disease Activity Score 28 with erythrocyte sedimentation rate (DAS28 ESR) was assessed as remission in 44 cases, low disease activity in 24, moderate in 33, and high in 4. The associations between the Locomo25 score and disease activity indices, bone mineral density (BMD), and bone turnover markers (TRACP-5b, NTX, urinary DPD, BAP, total P1NP, and 25(OH)D) were investigated.

Results:

Locomo25 grade was 0 in 37 cases (35.2%), 1 in 24 (22.9%), and 2 in 44 (41.9%). Locomo25 grade was significantly associated with Steinbrocker class (r= 0.4299, Spearman’s rank correlation coefficient,p< 0.0001). DAS28 ESR and Health Assessment Questionnaire scores increased as locomotive syndrome progressed. There was no significant difference in eGFR between groups, but bone resorption markers (TRACP-5b, NTX, and urinary DPD) and a bone quality marker (pentosidine) decreased significantly as locomotive syndrome progressed. There were no significant differences in BMD or other bone turnover markers.

Conclusion:

The Locomo25 score was useful for evaluating functional impairment in RA. The prevalence of Grade 2 locomotive syndrome in the general population is reported to be around 25%, and many patients with RA had advanced locomotive syndrome. Although there was no significant difference in BMD, elevated bone resorption and deteriorating bone quality were associated with progressive functional impairment, suggesting that RA patients with advanced locomotive syndrome may be at risk of increasingly severe osteoporosis as a result of immobility.

References:

[1]Yoshimura Y, Ishijima M, Ishibashi M, Liu L, Arikawa-Hirasawa E, Machida S, Naito H, Hamada C, Kominami E. J Orthop Sci. 2019 Nov;24(6):1094-1104. doi: 10.1016/j.jos.2019.08.009. Epub 2019 Sep 3.

[2]Siu PPY, Cheung PWH, Cheung JPY. J Orthop Sci. 2019 Nov;24(6):1110-1117. doi: 10.1016/j.jos.2019.07.012. Epub 2019 Aug 14.

Disclosure of Interests:

None declared

AB0964 THE ASSOCIATION BETWEEN RESIDUAL SYMPTOMS AND CERVICAL SPINE LESIONS IN RHEUMATOID ARTHRITIS

Background:

Treatment outcomes in rheumatoid arthritis (RA) have been improved with advances in drug therapy. In daily clinical practice, the outcomes are assessed based on the presence of swollen or tender joints, global assessment using a visual analog scale by a patient (GVAS) and a physician (DrVAS), etc., in addition to inflammatory findings. Although inflammation and joint symptoms are suppressed, many patients show no improvement in GVAS scores. The reported residual RA symptoms include morning stiffness (MS), pain (P), and dullness (D), but their causes are not completely known. Latent cervical spine lesions sometimes exist in RA, but their association with residual RA symptoms is unknown.

Objectives:

We examined cervical spine lesions and residual symptoms in patients with RA who achieved the therapeutic goal.

Methods:

Of 124 patients with RA, 82 (25 men and 57 women) who achieved a low disease activity (LDA) state on the Disease Activity Score for 28 joints with erythrocyte sedimentation rate (DAS28-ESR) were included. The mean age was 65.7 (28- 83) years, and the disease stage was Stage I in 28 patients, Stage II in 14, Stage III in 13, and Stage IV in 27. Dysfunction was graded as Class 1 in 63 patients, Class 2 in 18, and Class 3 in one (Steinbrocker classification). Biopharmaceuticals had been administered in 27 patients. As for disease activity, the DAS28-ESR scores indicated complete remission in 54 patients and LDA in 28. The survey form was used to investigate the presence or absence/duration of MS, the presence or absence/severity of P (Pain VAS), and the presence or absence/severity of D (Dullness VAS). On lateral functional radiographs of the cervical spine, patients with spinal lesions were selected and divided into the asymptotic stability (ASS; atlantoaxial dislocation ≥3 mm) + vertical setting (VS; Ranawat value <13 mm) group, the cervical spondylolisthesis group (≥3 mm of slippage on dynamic radiographs), and the spondylolisthesis group (≥3 mm of slippage on dynamic radiographs). They were examined for association with residual symptoms.

Results:

According to cervical spine lesions, the patients who achieved the therapeutic goal were divided into the ASS+VS group comprising 15 patients (18.3%), the spondylolisthesis group comprising 11 (13.4%), and the stenosis group comprising 18 (22.0%). Among them, only the spondylolisthesis group showed significant differences in residual RA symptoms. In the spondylolisthesis group, the disease duration was longer, but there was no difference in age. MS, P, and D were significantly severer. The duration of MS was longer, and both Pain and Dullness VAS scores were higher. The score on each component of the DAS28 showed no difference in inflammatory findings. GVAS and DrVAS scores were higher. No common perceptions of spinal symptoms were shared between any patients with cervical spine lesions and physicians.

Conclusion:

Improved patient-reported outcomes (PROs) are considered to be important to achieve more complete remission. There are various reports on the causes of residual RA symptoms, but many aspects remain unknown. Based on the results of this study, because asymptomatic subaxial subluxation is one of concerns in patients with spondylolisthesis with dynamic instability of the cervical spine, cervical spine diseases should also be considered in patients with severe residual symptoms. Not only radiography but also magnetic resonance imaging needs to be performed.

Acknowledgments:

The authors wish to acknowledge Miss Sasaki

Disclosure of Interests:

None declared

AB0899 TREATMENT STATUS OF PATIENTS WITH GLUCOCORTICOID-INDUCED OSTEOPOROSIS IN THE AKITA ORTHOPEDIC GROUP ON RHEUMATOID ARTHRITIS REGISTRY

Background:

Glucocorticoids (GC) have potent anti-inflammatory and immunosuppressive effects and are used to treat a variety of diseases. However, GC are associated with several adverse effects. Glucocorticoid-induced osteoporosis (GIO), a bone metabolism disorder, accounts for 25% of the side effects associated with GC, and long-term use of these agents leads to fragility fractures in 30 to 50% of patients [1]. GC are frequently used to treat rheumatoid arthritis (RA). No report on the current treatment status for glucocorticoid-induced osteoporosis (GIO) has been published following the publication of the new guidelines for the management and treatment of GIO issued by the Japanese Society for Bone Mineral Research provided in 2014 (Figure 1) [2].

Objectives:

The present study aimed to investigate the current treatment status of GIO patients in the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry.

Methods:

This retrospective, multicenter study included 683 patients (138 men, 545 women) with fracture risk factor scores ≥3 based on the new guidelines who were in the AORA registry. We examined patient characteristics, differences in patient backgrounds between treated and non-treated groups.

Results:

There were no significant differences in mean GC dose between men and women (4.0 ± 2.3 mg/day vs 3.6 ± 1.8 mg/day, p = 0.08). The mean disease duration of RA in women was significantly longer than in men (180.2 ± 140.2 months vs 143.8 ± 129.6 months, Untreated GIO patients were significantly more likely to be men and younger. The univariate analysis showed that clinic visits, male sex, younger age, and longer disease duration were significant risk factors for lack of therapeutic intervention for GIO. Multivariate analysis showed that being treated in a clinic, male sex, and younger age were significant risk factors for lack of therapeutic intervention for GIO.

Conclusion:

Our results emphasize the importance of considering the prevention and treatment of GIO in all patients with RA, including younger and male patients, who have lower intervention rates.

References:

[1]Weinstein RS. Clinical practice. Glucocorticoid-induced bone disease. New Engl J Med. 2011; 365(1): 62-70.

[2]Suzuki Y, Nawata H, Soen S, Fujiwara S, Nakayama H, Tanaka I, et al. Guidelines on the management and treatment of glucocorticoid-induced osteoporosis of the Japanese Society for Bone and Mineral Research: 2014 update. J Bone Miner Metab. 2014; 32(4): 337-350.

Disclosure of Interests:

None declared

How Different is the Core of ^{25}F from ^{24}O_{g.s.} ?

The structure of a neutron-rich ^{25}F nucleus is investigated by a quasifree (p,2p) knockout reaction at 270A  MeV in inverse kinematics. The sum of spectroscopic factors of π0d_{5/2} orbital is found to be 1.0±0.3. However, the spectroscopic factor with residual ^{24}O nucleus being in the ground state is found to be only 0.36±0.13, while those in the excited state is 0.65±0.25. The result shows that the ^{24}O core of ^{25}F nucleus significantly differs from a free ^{24}O nucleus, and the core consists of ∼35% ^{24}O_{g.s.}. and ∼65% excited ^{24}O. The result may infer that the addition of the 0d_{5/2} proton considerably changes neutron structure in ^{25}F from that in ^{24}O, which could be a possible mechanism responsible for the oxygen dripline anomaly.

Acetazolamide-Loaded Dynamic 7T MR Quantitative Susceptibility Mapping in Major Cerebral Artery Steno-Occlusive Disease: Comparison with PET

BACKGROUND AND PURPOSE

Dynamic changes in cerebrovascular reactivity after acetazolamide administration vary markedly among patients with major cerebral arterial steno-occlusive disease. MR quantitative susceptibility mapping can dynamically quantify the cerebral magnetic susceptibility. The purpose of this study was to determine whether dynamic changes in susceptibility after administration of acetazolamide on 7T quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in the cerebral hemispheres with major cerebral arterial steno-occlusive disease.

MATERIALS AND METHODS

Sixty-five patients underwent 7T MR imaging at baseline and at 5, 10, 15, and 20 minutes after acetazolamide administration. Differences between the susceptibility of venous structures and surrounding brain tissue were calculated in the quantitative susceptibility mapping images. Susceptibility differences at 5, 10, 15, and 20 minutes after acetazolamide administration relative to baseline were calculated in 97 cerebral hemispheres with major cerebral arterial steno-occlusive disease. CBV and the cerebral metabolic rate of oxygen were also calculated using ¹⁵O-gas PET in the resting state.

RESULTS

Dynamic changes of susceptibility after acetazolamide administration were classified into 3 patterns: abnormally increasing 5 or 10 minutes after acetazolamide administration; abnormally decreasing within 20 minutes after acetazolamide administration; and remaining unchanged after acetazolamide administration. CBV was significantly greater in the first pattern than in the latter 2. The cerebral metabolic rate of oxygen differed significantly in descending order from the first to middle to last pattern.

CONCLUSIONS

Dynamic changes of susceptibility after acetazolamide administration on 7T MR quantitative susceptibility mapping are associated with pre-existing states of CBV and the cerebral metabolic rate of oxygen in major cerebral arterial steno-occlusive disease.

Evaluation of a receptor gene responsible for maternal blood IgY transfer into egg yolks using bursectomized IgY-depleted chickens

In avian species, maternal immunoglobulin Y (IgY) is transferred from the blood to the yolks of maturing oocytes; however, the mechanism underlying this transfer is unknown. To gain insight into the mechanisms of maternal IgY transfer into egg yolks, IgY-depleted chickens were generated by removing the bursa of Fabricius (bursectomy) during egg incubation, and their egg production and IgY transport ability into egg yolks were determined. After hatching, blood IgY concentrations of the bursectomized chickens decreased gradually until sexual maturity, whereas those of IgA remained low from an early stage of growth (from at least 2 wk of age). Chickens identified as depleted in IgY through screening of blood IgY and IgA concentrations were raised to sexual maturity. At 20 wk of age, both blood and egg yolk IgY concentrations in the IgY-depleted group were 600-fold lower than those of the control group, whereas egg production did not differ between the groups. Intravenously injected, digoxigenin-labeled IgY uptake into the egg yolk was approximately 2-fold higher in the IgY-depleted chickens than in the controls, suggesting that IgY depletion may enhance IgY uptake in maturing oocytes. DNA microarray analysis of the germinal disc, including the oocyte nucleus, revealed that the expression levels of 73 genes were upregulated more than 1.5-fold in the IgY-depleted group, although we could not identify a convincing candidate gene for the IgY receptor. In conclusion, we successfully raised IgY-depleted chickens presenting a marked reduction in egg yolk IgY. The enhanced uptake of injected IgY into the egg yolks of the IgY-depleted chickens supports the existence of a selective IgY transport mechanism in maturing oocytes and ovarian follicles in avian species.